2022/11/15 NPG, Inc AKA: Nelson Paving & Grading, Goldstar Asphalt ProductsACORiJ CERTIFICATE OF LIABILITY INSURANCE DATE ([I9/DO/YYYY)
11t1412022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGI,ITS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEI{ THE ISSUING INSURER(S), AUTHORIZEO
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an AOOITIONAL INSUREO, the policy(ios) must have AODITIONAL INSUREO provisions or bo endorssd.
lf SUBROGATION lS WAIVED, subiect to the tcrms and condilions of the policy, certain polici€s may roquiro an endorsement. A atatement on
thi6 certificate does not confer rights to tho cortificate holder in lisu of such endorsement(s).
PRODUCER
Alliant lnsurance Services, lnc.
18100 Von Karman Ave 1oth Fl
lrvine CA 92612
License#: 0C3686 T
INSURED
NPG, lnc dba; Nelson Paving & Grading, Goldstar Asphalt Products
P.O. Box 1515
Perris CA 92572
COVERAGES CERTIFICATE NUMBER: 1 155631297 REVISION NUMBERI
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AAOVE FOR THE POLICY PERIOD
INDICAIED. NOTWITHSTANDING ANY REOUIREI\.{ENT. TERI' OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICA'TE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIIVITS SHOWN [,llAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR TYPE OF INSURAI{CE NUIlIBER
PROOUCTS, COMP/OP AGG
54310347 11t',l5t2022 1'11512423 s 1,000,000XEACH OCCURRENCE
DAIVAGE TO RENTED
COMMERCIAL GENERAL LIABILITY
$ 100,000
GENL AGGREGATE L MITAPPL]ES PERI GENERAL AGGREGATE
s
s2.000.000
s2,000.000
I ",-o,r"'roo, f o""r*
MED ExP (Any oie p6rson)
PERSONAL E AOV INJURY
$ 5,000
s 1.000,000
[ "o,,"" f ?E3; l ,o"
B AUTOIOBILELIABII-ITY-x elv auro- OWNEDAIITOS ONLYx ln:%o,,,, x
54310346
BOOILY NJURY (Pe. accideit) $
S
s
1111512022 1111512023
AOOILY INJURY (Perp€6on) I
s 1.000.000
SCHEOULEDAUTOS
NON.OWNEO
AUTOS ONLY
UMBREILALIAB
EXCESS LrAB CLAIMS.MADE
DED RETENT]ON $
' \ occun 5671 7269
AGGREGATE
$
$ 5,000,000
WORKERS COMPENSATIOIT
ANO EMPLOYERS' LIABILITY
ANYPROPRIEIOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDEO?
DESCRIPTION OF OPERATIONS bclos
54310348 111t2422
EL DISEASE. POLICY L MIT 91,000,000
OTH,ERtN
1t1t2023 x STATUTE
EG10010178 11115t2022 1'!/1512023 $2,000 000
$2,000,000
DESCRIPTIOII OF OPERAIIONS / LOCATIO'IS / VEHICLES (ACORO l0'! , A.rdltlon.l Rm.rt. Sch.dul., n.y b. rtt clr.rl ll mo.. .p.c. l. .rqolEd)
City of Menifee is named as Additional lnsured per attached endorsements. (30) Oays Notice of Cancellation / Non-Renewal - Ten ('10) Days Notice For
Non-Payment of Premium.
CERTIFICATE HOLDER CANCELLATION
City of Nrenifee
29714 Huan Rd.
[.4enifee CA 92586
SHOULD AI{Y OF TTIE ABOVE DESCRIBED POLICIES BE CAT'ICELLED AEFORE
THE EXPIRATION DATE THEREOF, NOTICE wlLL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESEI.ITATIVE
fu;/;p.q-oT-
O 1988.2015 ACORO CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORDACORO 25 (2016/03)
11t15t2122 11/15/2023 EAcHoccuRRENcE $5.OOO,OOOB
Sr-E4S!199ISE!I Lsl.ooo.go9
EL DISEASE. EAEMPLOYEE $ 1,OOO,OOq
B
l
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - AUTOMATIC STATUS FOR OTHER
PARTIES WHEN REQUIRED IN WRITTEN
GONSTRUCTION AGREEMENT
This endorsement modifies insurance provided under the following
COI\,4IVERCIAL GENERAL LIABILITY COVERAGE PART
poLTCyNUMBER: 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
injury", "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 to
provide for such additional insured.
A person's or organization's status as an
additional insured under this endorsement endswhen 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 afforded to these
additional insureds, the following addilional
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
"prope(y damage", or the offense which caused
the "personal and advertising injury", irvolved 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 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 locatron of the covered
operations has been completed; or
cG 20 38 04 13 @ lnsurance Services Office, lnc.,2012 Page I 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
Section lll - Limits Of lnsurance:
The most we will pay on behalf of the additional
insured is the amount of insurance:
'1. Required by the contracl or agreement
described in Paragraph A.l.; or
2. Available under the applicable Limits
lnsurance shown in the Declarationsi
whichever is less.
This endorsemenl shall not increase
applicable Limits of lnsurance shown in
Declarations.
of
the
the
Page 2 ol 2 O lnsurance Services Office, lnc.,2012 cG 20 38 04 13
PoLICY NUIVIBER: 54310347
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED. OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifes insurance pro\,ided under the following
COI\i] I\,1ERCIAL GENERAL LIABILIry COVERAGE PART
SCHEDULE
Name Of Additional ln$red Person(s)
Or Organization(s)Location(s) Of Covered Operations
VIHERE REQUIRED BY WRITTEN CONIRACT.A],L LOCAT]ONS WHERE REOUIRED BY WRITTEN
CONTRACT
lnformation required to complete this Schedule, if not shown abo\e, will be shown in the Declarations
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 for "bodily injury", "property
damage" or "personal and ad\Ertising injury"
caused, in whole or in part, by:
1. Your acts or omissionsl or
2. The acts or omissions of those acling on your
behalf;
in the performance of your ongoing operations forthe additional insured(s) at the location(s)
designated abo\e.
Howe\€r:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. lf co\Erage 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
provde for such additional insured.
B. With respect to the insurance afforded to theseadditional 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 fumished in connection with such
work, on the proJect (other than senice,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
Iocation 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 another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
cG 20 10 12 19 O lnsurance Services Offce, lnc., 2018 Page I ol 2
COMNERCIAL GENERAL LIABILITY
cG 20 10 12 19
C. With respect to the insurance afiorded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf co\erage 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. A\ailable under the applicable limits of
insurance;
whicheler is less.
This endorsemenl shall not increase the
applicable limits of insurance.
Page 2 ot 2 @ lnsurance Services Offce, lnc., 2018 cG 20 10 12 19
THIS EN DORSEMENT CHANGES TH E POLICY. PLEASE READ IT CAREFU LLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
COMMERCIAL GENERAL LIABILIry COVERAGE PART
PRODUCTS/COI\,IPLETE D OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
PoLICY 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 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 endorsementperformed for that additional insured and
included in the "products-completed operations
hazard".
Howe\€r:
1. The insurance afforded to such additional
insured only applies to the extent permitted
by law; and
2. lf co\erage 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
pro\ide for such additional insured.
COMMERCIAL GENERAL LIABILITY
cG 20 37 12 19
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf co\erage 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. A\ailable under the applicable Limits of
lnsurance shown in the Declarationsi
whiche\€r is less.
This endorsement shall not increase the applicable
Limits of lnsurance shown in the Decla€tions.
Name Of Additional lnsured Person(s)
Or Organizatlon(s)Location And Description Of Completed Operations
WITERE REQUIRED BY WRITTEN CONTRACT, BUT
ON],Y VIIIEN THE CONTRACT SPECIFIES COVERAGE
FOR COMPLETED OPER.ATIONS
AIL IOCATIONS WHERE REQUIRED BY WRITTEN
CONTR,ACT
lnformation required to complete this Schedule, if not shown abo\e, will be shown in the Declarations
cG 20 37 12 19 O lnsurance Senices Offce, lnc.,2012 Page 1 of 'l
This endorsement modifies insurance pro\,ided under the following:
PoLICYNUMBER: 54310347 COMMERCIAL GENERAL LIABILITY
10-02-24$1 (Ed. 7-1s)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY INSURANCE FOR
SCHEDULED ADDITIONAL INSURED
This endorsement modities insurance provided under the following:
COMMERCIAL GENERAL LIABILIry COVERAGE PART
AddiUonal lnsured:
Per written contract
SCHEDULE
Location O{ Covered Operations:
(lf no entry appears above, information required to complele this endorsement will be shown in the Declarations
as applicable to this endorsement.)
With respecl only to the Additional lnsured and at the
Location Of Covered Operations shown in the
Schedule, the following is added to SECTION lV -
COMMERCIAL GENERAL LIABILITY CONDITIONS,
Paragraph 4. Other lnsurance and supersedes any
provision to the contrary:
Primary And I{oncontributory lnsurance
This insurance is primary to and will not seek
contribution from any other insurance available to
the Additional lnsured with respect to the Location
Of Covered Operations shown in the Schedule
under this policy provided that:
(1) The Additional lnsured is a named insured
under such olher insurance; and
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution fromany olher insurance available to the
Additional lnsured.
1042-2161(Ed. 7-f$ lncludes copyrighted malerial of lnsurance Services Office, lnc.,
with its permission.
Page I of 1
PoLICY NUMBER: 54310347
b. Those statements 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 Waivor 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 againsl 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
afler loss to impair them. At our request, 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 nol 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 sufficient
proof of notice.
SECTION V - DEFINITIONS
1. "Advertisement" means an electronic, oral, written
or olher notice, about goods, producls 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 injury'', "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:
Form 10-02-1800 (Rev. 09-
't7l
COMMERCIAL GENERAL LIABILITY
a. Copyrighted "advertisement"; or
b. Registered collective mark, registered service
mark or other registered trademarked name,
slogan, symbol or title.
3. "Asbestos" means asbestos in any form, including
ils 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 responsibilily 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. lnjury;
b. Sickness; or
c. Disease;
sustained by a person, including resulting death,
humiliation, mental anguish, mental iniury 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
Canadat
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. abovei or
c. All other parts of the world if the injury or
damage arises out of:
(1) Goods or producls made or sold by you in
the territory described in Paragraph a.
above:
(2) The activities of a person whose home is in
the territory 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
lncludes copyrighted material of ISO Properties, lnc., with
its permission
Page 13 of 17
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
Designat6d Construction Project(s):
Per rvritten 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 Project
General Aggregate Limit applies to each des-
ignated construction prolect, 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 mosl 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 construclion 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 forany 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 lvledical Expense continue to apply.
However, instead of being subject to the
General Aggregate Limit shown in the Decla-
rations, such limits will be sublect to the appli-
cable Designated Construction Prqect Gen-
eral Aggregate Limit.
cG 25 03 05 09 O lnsurance Services Office, |nc.,2008 Page l ol2 tr
poltcy NUMBER: 54310347
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 Aggregate
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
"producls-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 otherwise modified by this endorsement
shall continue to apply as stipulated.
Page 2 ol 2 O lnsurance Services Offlce, lnc., 2008 cG 2s030s09 tr
COMMERCIAL AUTON'IOBILf
THIS ENDORSE]\{ENT CHANGES THE POLICY. PLEASE READ I't CARE}'ULLY.
COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
This endorsement modifies the Business Auto Coverage Form1. EXTENDED CANCELLATION CONDITION
Paragraph 4.2.b. - CANCELLATION - of the
COMMON POLICY CONDITIONS form lL 00 17 is
deleted and replaced with the following:b. 60 days befrcre the effeclive date of cancellation if
!r€ cancel for any other reason.2. BROAD FORM INSUREOA Subsidlarios and Newly Acqulred or Formed
Organizatlons As lnsureds
The Named lnsured shown in the Declarations is
amended to include:
1. Any legally incorporated subsidiary in which
you own more than 50% of the voting stock on
he efieolive date of the Coverage Form.
However, 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 ot
ln surance.
2. Any organization that is acquired or brmed by
you and over which you maintain ma.iority
ownership. However, the Named lnsured
does not include any newly formed or acquired
organization:
(a)That is an "insured" under any olher
artomobile policy;
(b) That has exhausted its Limit of lnsurance
Lnder any other policy; or
(c) 180 days or more after its acquisition or
brmation by you, unless you have given
us written notice of the acquisition or
brmation.
Coverage does not apply to 'bodily injury" or
"property damage" that resjlts from an "accident"
hat occurred before you formed or acquired the
cganizalion.
B. Employees as lneureds
Paragraph A.1 . - WHO lS AN INSURED - of
SECTION ll - LIABILITY COVERAGE is amended to
add the bllowing:d. Any'employee" of yours while using a
covered "auto" you don't own, hire or
bonorv in your business or your personal
dfairs.
C. Lessors as lnsureds
Paragraph A.1. - WHO lS AN INSURED - of
SECTION ll - LIABILITY COVERAGE is
amended to add the following:e. The lessor of a mvered "auto" while the
"auto" is leased to you under a written
agreement if:
(1) The agreement requires you lo
provide direc,t primary insurance for
the lessor; and
(2) The "auto" is leased without a driver.
Such leased "auto" will be considered a
mvered "auto" you own and not a covered
"auto" you hire.
l-lo\ ever, the lessor is an "insured" only
br "bodily injury" or "property damage"
resulting from the 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. andlot 2.
Fonn: 16-02-0292 (Rev. 4-l l) Page I of3
"lncludes mpyrighted material of lnsurance Services Office, lnc. with its permission"
POLICYNUMBER: 54310346
D. Persons And Organlzations As lnsureds
Under A Written lnsured Contrac't
Paragraph A.1 - WHO lS AN INSURED - of
SECTION ll - LIABILITY COVERAGE is
amended to add the following:f. Any person or organization with respecl to
he operation, maantenance or use of a
covered "auto", provided that you and
such person or organization have agreed
tnder an express provision in a written
"insured contracl", writlen agreement or a
written permit issued to you by a
governmental or public authority to add
sJch person or organization to this policy
as an "insured".
llowever, such person or organization is
an "insured" only:
(1) with respecl to the operation,
maintenance or use of a covered
"auto"; and
(2) for "bodily injury" or "property damage"
caused by an .accidenf which takes
place after:
(a) You executed the "insured
contract" or written agreement; or
(b) The permit has been issued to
\ou.3. FELLOW EMPLOYEE COVERAGE
EXCLUSION 8.5. - FELLOW EMPLOYEE - of
SECTION ll - LIABILITY COVERAGE does not apply.4. PHYSICAL DAMAGE - AOOITIONAL TEMPORARY
TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a. - TRANSPORTATION EXPENSES
- of SECTION lll - PHYSICAL DAMAGE
COVERAGE is amended to provide a limit of $5O per
day for temporary transportation expense, subject to 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 the followingi
c. Unpaid Loan or Leaso Amounts
ln the event of a total "loss" to a covered "auto", we will
pay any unpaid amounl due on the loan or lease lor a
covered "auto" minus:1. The amount paid under the Physical Darnage
Coverage Seclion of the policy; and2. Any.a. Overdue loan/lease payments at the time of
he "loss":
b. Financial penalties imposed under a lease for
excessive use, abnormal wear and tear or
high mileage:c. Security deposits not returned by he lessor:d. Costs for exlended warranlies, 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
Declarations indic€te that Comprehensive
Coverage is provided for any covered 'auto":2. Specified Causes of Loss Coverage only if the
Declarations indicale that Specified Causes of
Loss Coverage is provided for any covered "auto";
or
3. Collision Coverage only if the Declaralions 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 following:
d. Rental Expense
We will pay the following expenses that you or
any of your "employees" are legally obligated
to pay because of a written contract or
agreement entered into for use of a rental
vehicle in the conducl of your business:
IVIAXIMUM WE WILL PAY FOR ANY ONE
CONTRACT OR AGREEMENT:1. $2,500 for loss of income incuned by the
rental agency during the period of time that
vehicle is oul of use because of aclual
damage to, or "loss' of, that vehicle, including
inmme lost due to absence of that vehicle for
use as a replacement;2. S2,500 for decrease in trade-in value of the
rental vehicle because of aclual damage to
hat vehicle arising out of a covered "loss"; and3. $2,500 for adminislrative expenses incurred
by the rental agency, as stated in the contract
or agreement.4. $7,500 maxinum total amounl for paragraphs
1.,2. and 3. combined.7. EXTRA EXPENSE - BROADENED COVERAGE
Paragraph A.4. - COVERAGE EXTENSIONS - of
SECTION III - PHYSICAL DAMAGE COVERAGE
is amended to add the following:e. Recovery Expense
We will pay for the expense of returning a
stolen covered "auto" to you.
8. AIRBAG COVERAGE
Paragraph B.3.a. - EXCLUSIONS - of SECTION
lll - PHYSICAL DAMAGE COVERAGE does not
apply to the accidental or unintended discharge of
l airbag. Coverage is excess over any other
colle6{ible insurance orwarranty specifi cally
designed to provide this coverage.9. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT. BROADENED COVERAGE
Paragraph C.2. - LIMIT OF INSURACE - of
SECTION lll - PHYSICAL DAMAGE is deleted
md redaced with he following:
2. $2,000 is the most we Wll pay for "loss" in any
one "accident" to all eleclronic equipment that
reproduces, receives or fansmits audio, visual
or data signals which, at the time of "loss", is:
a. Permanently installed in or upon the
mvered "auto" in a housing, opening or
cther location that is not normally used by
he "auto" manufacturer for the installation
d 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; or
c. An integral part of such equipment.
Form: 16-02-0292 (Rev.4-l l) Page 2 of3
"lndudes copyrighted matedal of lnsurance Services Offce, lnc. with its permission"
10. GLASS REPAIR - WAIVER OF DEDUCTIBLE
Under Paragraph D. - DEDUCTIBLE - of
SECTION III - PHYSICAL DAMAGE COVERAGE
he following is added:
l,,lo deduclible applies tc glass damage if lhe glass
is repdred rather lhan replaced.
11. TWO OR MORE DEDUCTIBLES
Paragraph O.- DEDUCTIBLE - of SECTION lll -
PHYSICAL DAMAGE COVERAGE is amended to
dd the follol /ing:
lf this Coverage Form and any other Coverage
Form or policy issued to you by us that is not an
a:tomobile policy or Coverage Form apdies to the
same "accident', the follo\ ring applies:1. lf the deductible under this Business Auto
Coverage Form is the smaller (or smallest)
deductible, it wiil be waived; or2. lf the deduclible under this Business Auto
Coverage Form is not the smaller (or smallest)
dedudible, it will be reduced by the amount of
the smaller (or smallest) deduclible.
12, AMENDED OUTIES IN THE EVENT OF
ACCIDEiIT, 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 kno\ rn 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 officer, insurance manager,
d authorized representative, if you are an
trganizatjon other than a partnership or
limited liability company.
Kno/yledge of an "acodent", claim, 'suit" or
'loss" by other persons does not imply that the
persons listed above have such knowledge.
flotice to us should include:
(1) Ho\iv, when and where the "accident" or
"loss" occurred:
(2) The "insured's'name and address; and
(3) To the e)dent possible, the names and
ddresses of any injured persons or
applies, provided the "insured" has waived
their rights ol remvery against such person or
organization under a conlract or agreement
hat is entered into before such "loss".
To the exlent 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 transfened to
us. That person or organization must do
eveMhing necessary lo secure our rights and
must do nothing afler "accident" or "loss" to
impair them. Al our request, the insured will
bring suit or transfer those rights to us and
help us enforce them.
14, UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
Paragraph B.2. - CONCEALMENT,
MISREPRESENTATION or FRAUD of SECTION
M - BUSINESS AUTO CONDITIONS - is deleted
and redaced wih the following:
lf you unintentionally fail to disclose any hazards
existing at the inception date of your policy, we will
mt void coverage under this Coverage Form
because of such failure.
.I5. AUTOS RENTED BY EMPLOYEES
Paragraph B.5. - OTHER INSURANCE of
SECTION IV _ BUSINESS AUTO CONDITIONS -
is amended to add the illlowing:e. Any "auto'' hired or rented by your "employee"
on your behalf 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 direction, this insurance will be
primary to the "employee's" personal
insu rance.
16. HIRED AUTO - COVERAGE TERRITORY
Paragraph B.7.b.(5).(a) - POLICY PERIOD,
COVERAGE TERRITORY cf SECTION lV -
BUSINESS AUTO CONDITIONS is delded and
replaced with the following:
(a) A mvered .auto" of the privale passenger
type is leased, hired, rented or bonowed
without a driver for a period of 45 days or
less: and.I7. RESULTA}IT MENTAL ANGUISH COVERAGE
Paragraph C. of - SECTION V - DEFINITIONS is
deleted and replaced by the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by any person, including
rnental anguish or death as a result of the "bodily
iliury" sustained by that person.
Form: 16-02-0292 (Rev.4-l l) Page 3 of3
"lncludes copyrighted material of lnsurance Services Office, lnc. with its permission"
13. WAIVER OF SUBROGATION
Paragraph A.5. - TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US of
SECTION lV - BUSINESS AUTO CONoITIONS is
deleted and replaced with the following:5. We will waive the right of recovery we would
otherwise have against another person or
organization br "loss" to which this insurance
POLICYNUMBER: 54310346 COMMERCIAL AUTO
16-02-0316 Ed. 10 14
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
PRIMARY AND NON.CONTRIBUTORY LIABILITY
INSURANCE
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
modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named lnsured:NPG, lnc aka: Nelson Paving & Grading, Goldstar Asphalt Products
Endorsement Effective gals' 1 1 l1 512022
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
WHERE REQUIRED BY WRITTEN CONTRACT.
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations
The following is added to ltem 5. - "Other
lnsurance" 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 in 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. 1014 Page 1 of 1
workers' Comp6nsation and Employers' Liability Policy
Named lnsured
NPG, lnc aka: Nelson Paving & Grading. Goldstar
Asphalt Products
Endorsement Number
Policv Number
svmoor, wcr xum5sp 54310348
Effective Date of Endorsement
01t01t2022
Policv Period
01 101 12022 to 01 101 12023
lssued By (Name nsurance Company)
FEDERAL INSURANCE
t'o.r rs to be cornpleted only when tl'rs endorsems!!1! l!!!9!j!!!9q reparation ol the policyInserl the policy numb6r. The romainder the in
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 in.iury 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 in.jury 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 75 (05/18)
Authorized Representative