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2021/10/25 Reliable Concrete Accessories10122t2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGANVELY A"END, 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 HOLOER. IMPORTANT: If the certificate hold.r is an ADDITIONAL INSUREO, the policy(ies) mu6t have ADDITIONAL lNSURED provisions or be endorsed tf SUBROGATTON tS WAIVEO, subjsct to the terrns end conditions of the policy, certain policies may require an endorcement. A 3tatement on this certificate does not conle. rights io the certiticate holder in lieu ot 3uch endorsement(s) PRoDUCER Edoewood Partners lnsurance Cenler (EPIC)'19d00 MacArthur Blvd. PH Floor lrvine, CA 92612 www edgewoodins com Reliable Concrete Accessories 7600 Redondo Circle Huntington Beach CA 92648 263-0606 I 263-0906 AFFORDINC COVERAGE TNSURERA: Pennsylvania Lumbermens MutUal lnsurance Co 14914 National lnsurance C 19879 American lnsurance 16691 cAD'CERTIFICATE OF LIABILITY INSURANCE COVERAGES TNIS IS TO CERTIFY THAT IHE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUEO TO THE I INDICATED NOTWTHSTANDING ANY REOUIREMENT, TERM OR CONOIIION OF ANY CONTRACT OR O IJSUREO NAMEO ABOVE FOR THE POLICY PERIOO TI.]ER DOCUi/IENT WTH RESPECT TO WtlICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES LIMITS SHOVIII MAY HAVE BEEN REDUCEO BY PAIO CLAIMS COM M ERC IAL GENE R L LIABILITY GEN ! AGGRECATE LIM]T APPLIES PER "ou", E:ff; f-l ,o" 04-R013 01-21 1012512021 1012512422 s1 000 000 s 100 000 gl 000 000 PREUTSES (EE dcumnc.) MED EXP (A^y o^. p.tro.l PERSONAL A ADV lNJURY G€NERAL AGGREGAT E ! 2.000 000 PRODUClS . COMP/OP AGG $2.000 000 AU'IO MOBILE LIABIU IY HIREO DOC 04-R013 02-21 1412512021 10t2512022 COUBINEDSINCLELMT t1 000 000 BOOILY INJURY (P.. p.Bon)s aoDrLY TNJURY (P.r aeid.nl) s s 04-R013,03,21 14t2512021 14t2512022 !5 000 000 s 5,000,000 OED 5s1gx116p 310 000 B TIloRKERSCOHPENSAIION ANO EMPf OYERS' L|AAILITY ANYPROPR]ETOR/PARTNER/EXECUTUE OFFICER/MEMAER EXCLUOEOT oEsCRIPTION OF OPERATIONS bd@ s\^,c1361650 1011t2421 1011t2022 ST OTH $ 1 000,000 FL DISEASE EAEMPLOYEE t I 000 000 i 1.000,000E L DISEASE. POL CY LIMII c lniand Marine - Scheduled Equipment Excess Liabrlily $5Mi, Excess of $5M[ 04-R013-01,21 TAU950O 1012512021 10t25t2021 10125t2022 10t2512022 $3,807,441.73 52,500 Oeducirble ACV $5,000,000 Each Occunence $5.000 000 Aqqregale Limil DESCRTPT|o OF OpERATIONS / LOCAIOitg t VEHrCttS IACORO lol, Addnon.l R.tu,t S.h.d!l., y b. rll..h.d n llm .r.c. l. oqd.d) The Crty of Menrf€e. the City ol irenifee Communrty S€rvlces. the Menrb€ HousingAuthor yand each of l herr officers. olfrcsls empuy6es, agents and volJnleers are rnctuded asAddrtonat lnsureds as respecticeneral Llabrlly andAllomobrle Llabrl(y.rnsurance per attached inri.iieminii ei^ary anJ Hon-Conrnoutoiy ra,ordrng a pphes per aflachod dndors€menr (s). V,iaiGr of Su brogatron on l brkers C ompensalron and Lmotc,vers Liabrtrtv insirrEnce as respects lo ihe C[y o_f Mdnrbd, lh€ Cily ol Menfee Communrty S€rv,ces Otstrrcl. lhe Minibe Hoisrig Arthonly and each of lherr oflicers, employees, agents and volunlee6 per atlached endo66menl CERTIFICATE NUTIBER: 6466 REVISIOiI }IUMBER CERTIFICATE HOLDER CANCELLATION Citv of Menrfee 29844 Haun Road Menifee CA 92583 SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIFIATION DATE THEREOF, NOTICE WLL BE DELIVEREO IN ACCOROANCE I/VITH THE POLICY PROVISIONS. ?4 t p'"*- Anlhony O'Asaro ACORO 2s (20r6/031 O 1988.2015 ACORD CORPORATION. All,ight! re3orvod Tho ACORD namo and logo rr. regl3torcd markB oIACORO des AIL rrevrcusl! ,esue.l cerrrftcaL.s. I POLICY EFF I POLICY EXP il I I I llcl iilblc Concrctc Acccssorics !0/:2/2021 0l-lt0 B-0 t-2 |COMMERCIAL GENERAL LIABILITY LUM-145 02 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROAD FORM ADDITIONAL INSURED COI\,1I\4ERCIAL GENERAL LIABILITY COVERAGE PART 1. Broad Form Additional lnsured Paragraph 2. of Section ll - Who ls An lnsured of Gommercial General Liatility Coverage Form CG 00 0l is amended to add lhe following: e. Additional lnsured by Written Contract or Written Agreement The followang are ansureds 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 Ior "bodily inlury", "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". Wth resped to the insurance afforded to hese additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. 12\ Owners, Managers or Lessors of Premises or Land: any owner, manager or lessor of premises or land, but only with respect to their liability arising out ot or caused, in vvhole or in part, by ownership, maintenance or use ofthat part of such premises or land leased lo 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 allerations, new construction or demolition operations perfurmed 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 respecl 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 alteralions, new conslruction 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 Iiability 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 nol apply to any agreemenl to provide insurance to. (i) 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", associalion of "employees" or labor union as owners; LUM-145 02 06 Pennsylvania Lumbermens Mutual lnsuratce Company Philadelphra, Pennsylvania Yo-neb.,q ro/?2/?0rrTh'r c.rrrr 1p -d|ats arI supersedes AIL pr-vrouiL! rssJed cerL.t,.drps. Page 1 of3 This endorsement modifies insurance provided under the following: LUM-145 02 06 (iD Any railroad company except with respect to work performed by you or for you for such railroad company under direct contEct or agreernent 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 io liability arising out of preparation or approval of maps, drawings, opinions, reports, surveys, change orders, designs or specifications; giving directions or instruclions, lailing to give directions or instructions; or the performance of any other professional services by such person or organization, (iv) Any of your contractors or subconlraclors or any partner, officer, agent or "employee" of such contractors or subconlraciors; and (v) Anyone described in Paragraphs e.(1) through (3) above. (b) lf a vendor of "your products" is an additional insured under this Coverage Form, such insurance as provided to the addational insured applies only with respect to "bodily injury" or "properly damage" arising out of'your products'which are distrjbuted or sold in the regular course of the vendo/s business and subject to the bllowing 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" unaulhorized by you, (iii) Any physicalor chemicalchange in "your products" made intentionally by such vendor; (iv) Repackaging, unless unpacked solely for the purpose of inspection, demonslration, testing or the substitution of parts under insttuctions from you or the manufacturer, and then such parts are repackaged in the original containeri (v) Any failure to make such inspections, adjuslments, 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 prodJcts"; (vi) Demonstration, installation, servicing or repair operations except such operalions performed at the vendor's premises in ccnnection with the sale of "your producls"i or (vii) Any of "your products' which, after distribution or sale by you, have been labeled or relabeled or used as a conlainer, part or ingredient of any other item or substance by or for the vendor. This insurance afforded to the vendors in (4Xb) above does not apply to any person or organization from whom you have acquired such products, ingredients, parts or containers entering into, acconpanying or containing "your products'. No insurance is provided under this vendor's coverage in (axb) if "bodily injury" or "property damage" under the "products-compleled operalions hazard" is excluded by any exclusions or provisions of thrs 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 extenl that such insurance is induded within the terms of this policy, and that person's or organization's stalus as an additional insured under this endorsement ends: (a) when your operations for lhat additional insured are completed or (b) when any written contract or agreement with such person or organization is terminated or expires. Pennsylvania Lumbermens Mutual lnsurance Company Phrladelphia. Pennsylvanra an.els and supersedes ALL p.ev.ors,v 1ssu.o certrfr(aLes. Page 2 of 3 (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) ls subject to all applicable exclusions of Paragraph 2. Exclusions, Coverage A (Section l). (iv) Does not include any person or organization included as an insured under the provisions of Section ll - Who ls An lnsued 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 pdicy. (e) The insurance afforded to any person or organization as an additional insured under this Paragraph 2.e.(l) 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 lnsurance The insurance afforded to any additional insured under Paragraph 2.e.('l ) through (4) will be primary and non- contributory if required by such contEct or agreement with you. 3. Waiver of Right of Recovery by Written Contract or Agreement We waive any right of recovery lo paymenls we make for injury or damages arising out of your ongoing operations or "your work" included in the "products-completed operalions hazard". This applies to any person or organization wiih whom you have agreed in a written conlracl or agreement made prior to the date of the "occurrence" lo 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 agreernent. LUM-145 02 06 Pennsylvania Lumbermens Mutual lnsurance Company Philadelphia. Pennsylvania .e 'dn'cls and supersedes AIL pre,;rou31y rssued.errrlr.d.ca. Page 3 of 3 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY wc 00 03 13 (Ed.04-84) Schedule Any person or organization as required by written contract 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 Etfecliverc1o112t2l Policy No. S\\C13616s0 Endorsement No. lnsured p";1"61" 6qn6rete Accessones lnsurance Company Security National lnsurance Company Countersigned by wc 00 03 13 (Ed.04-84) l tri :i .errr tr.;i. (:ad..lr .n.l supersedes Al,l, EreviousLy issu€d ilr!tr f icates, We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right againat the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract thal requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Q\yg'"*- WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT llcl iablc Concretc Acccssorics POLICY NUMBER: 0.1-R013-02-2 I COMI\TERCIAL 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 lS AN INSURED provision of Section ll- LIABILITY COVERAGE. B, For any person or organization for whom you are required by contract to provide a waiver of subrogalion, the Loss Condition- TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US is not applicable. C. The insurance afforded to any addilional insured whom youare required by contract to name as an additional insured will be PRIMARY AND NON-CONTRIBUTORY by such contracl or agreement with you. Thip 1rr l''"r. cdr -ls and qupp,sedes A_L prevlo!sIy issu.d .errrrtcdtes.