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11-0802_AMERICAN ASPHALT_InsuranceACCORD CERTIFICATE OF LIABILITY INSURANCE DATE (MIVUDDATYY) 08/10/2011 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must 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). PRODUCER Lie #0B29370 1-925-244-7700 Edgewood Partners Insurance Centers (EPIC) [Orange Brctnch] P.O. Box 5003 San Ramon, CA 94583 NAlvlEf^^ Certificate Department PRODUCER Lie #0B29370 1-925-244-7700 Edgewood Partners Insurance Centers (EPIC) [Orange Brctnch] P.O. Box 5003 San Ramon, CA 94583 fflc.'NaExfl: (925) 244-7700 WC,No): (925) 901-0671 PRODUCER Lie #0B29370 1-925-244-7700 Edgewood Partners Insurance Centers (EPIC) [Orange Brctnch] P.O. Box 5003 San Ramon, CA 94583 AISDRESS: EPICcerts@EdgewoodIns.com PRODUCER Lie #0B29370 1-925-244-7700 Edgewood Partners Insurance Centers (EPIC) [Orange Brctnch] P.O. Box 5003 San Ramon, CA 94583 INSURER(S) AFFORDING COVERAGE NAIC# PRODUCER Lie #0B29370 1-925-244-7700 Edgewood Partners Insurance Centers (EPIC) [Orange Brctnch] P.O. Box 5003 San Ramon, CA 94583 INSURER A: ARCH SPECIALTY INS CO 21199 INSURED All American Asphalt P.O. Box 2229 Corona, CA 92878-2229 INSURERS: HARTFORD FIRE IN CO 19682 INSURED All American Asphalt P.O. Box 2229 Corona, CA 92878-2229 INSURERS: NATIONAL UNION FIRE INS CO OF PITTS 19445 INSURED All American Asphalt P.O. Box 2229 Corona, CA 92878-2229 INSURERS: SEABRIGHT INS CO 15563 INSURED All American Asphalt P.O. Box 2229 Corona, CA 92878-2229 INSURER E: INSURED All American Asphalt P.O. Box 2229 Corona, CA 92878-2229 INSURER F: COVERAGES CERTiFICATE NUMBER: 22673651 REVISION NUMBER: 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 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR WVD POUCY NUMBER POUCY EPF (MMfDDfYYYYI POUCY EXP (MM;DD/YYYYI UMITS GENERAL LIABILITY GPP002265803 08/01/13 08/01/13 COMMERCIAL GENERAL LIABILITY CLAIMS-MADE EACH OCCURRENCE DAMAGE TO RENTED PREMISES fEa occurrencel MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE POLICY GEN'L AGGREGATE LIMIT APPLIES PER: LOC PRODUCTS - COMP/OP AGG 08/01/13 08/01/12 $ 1,000,000 $ 100,000 J 1,000,000 $ 2,000,000 $ 2,000,000 AUTOMOBILE LIABILITY 72UENGK5491 COMBINED SINGLE LIMIT fEa acddenti $ 1,000,000 ANY AUTO ALL OWNED AUTOS HIRED AUTOS BODILY INJURY (Per person) SCHEDULED AUTOS NON-OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE fPeracddenll UMBRELLA LIAB EXCESS LIAB DED OCCUR CLAIMS-MADE BE21422933 08/01/13 08/01/12 EACH OCCURRENCE $ 10,000,000 AGGREGATE S10,000,000 RETENTIONS 10, 000 WORKERS COMPENSATION AND EMPLOYERS' LIABILrTY y , (j ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEFUMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below BB1110243 08/01/11 08/01/12 WCSTATU-^ I TORY LIMITS OTH-ER N N/A E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Pavement Rehabilitation Improvement Project [2] CERTIFICATE HOLDER CANCELLATION City of Scin Juan Gapistrano Ptjblic Works Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 32400 Paseo Adelanto AUTHORIZED REPRESENTATIVE San Juan Gapistrano, CA 92 675 1 USA © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) r jolmsonl-org 22673651 The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF-INSURED RETENTION COVERAGE FORM SECTION II - WHO IS INSURED Is amended to Include as an additional Insured those persons or organizations who are required under a written contract with you to be named as an additional Insured, but only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused, In whole or in part, by your acts or omissions or the acts or omissions of your subcontractors: A. in the performance of your ongoing operations or "your work", including "your work" that has been completed; or B. in connection with premises owned by or rented to you. As used In this endorsement, the words "you" and "your" refer to the Named insured. Ail other terms and conditions of this Policy remain unchanged. Schedule Project City of San Juan Gapistrano RE: Pavement Rehabilitation Improvement Project Endorsement Number This endorsement Is effective on the Inception date of this policy unless otherwise staled herein (The Information below Is required only when this endorsement Is issued subsequent to the preparation of the polity.) Policy Number GPP002265803 Named insured: Ail American Asphalt Endorsement Effective Date: 8/1/11 00 CGL0006 00 05 07 2511 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - BROAD FORM, CGL POLICY ENDORSEMENT This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF-INSURED RETENTION COVERAGE FORM Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following paragraph is added to Condition 4. Other Insurance: Where the Named Insured is required by a written contract to provide insurance that is primary and non-contributory, and the written contract so requiring is executed by the Named Insured before any "occurrence" or offense, this insurance will be primary, but only if and to the extent required by that written contract. All other terms and conditions of this Policy remain unchanged. Schedule Project City of San Juan Gapistrano RE: Pavement Rehabilitation Improvement Project Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Policy Number: GPP002265803 Named Insured: All American Asphalt Endorsement Effective Date: 8/1/11 00 COL0130 00 09 06 Page 1 of 1 2511 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF-INSURED RETENTION COVERAGE FORM Schedule Project City of San Juan Capistrano RE: Pavement Rehabilitation Improvement Project UnderSECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 8. Transfer Of Rights of Recovery Against Others to Us is amended by the addition of the following provision: We waive any right of recovery we may have against the person or organization shown in the SCHEDULE above because of payments we make for injury or damage arising out of your operations or "your work" done under a written contract with that person or organization. All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: GPP0022658-03 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/11 00 CGL0121 00 09 06 includes Copyright Material from insurance Services Office, inc., with its permission. Page 1 of 1 t All American Asphalt Policy #72UENGK5491 8/1/11 to 8/1/12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED AND RIGHTS OF RECOVERY AGAINST OTHERS This endorsement modifies insurance provided underthe 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 UABILITY COVERAGE but only to the extent that person or organization qualifies as an "insured" underthe WHO IS AN INSURED provision of Section II - LIABILITY COVERAGE. B. For any person or organization for whom you are required by contract to provide a waiver of subrogation, the Loss Condition - TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US is applicable. Schedule Project RE: Pavement Rehabilitation Improvement Project City of San Juan Capistrano Form HA 99 13 01 87 Printed in U.S.A. Page 1 of 1 2511 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from US.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be * % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description City of San Juan Capistrano RE: Pavement Rehabilitation Improvement Project WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO OBTAIN THIS AGREEMENT FROM US, PROVIDED THE CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE SHALL THE PROVISIONS AFFORDED BY THIS ENDORSEMENT BENEFIT ANY COMPANY OPERATING AIRCRAFT FOR HIRE. * The premium charge for this endorsement shall be 2% of the premium developed in the State of California, but not less than $500 policy minimum premium. 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 Effective 8/1/11 Policy No. BB1110243 Endorsement No. insured All American Asphalt Policy Effective Date 8/1/11 Insurance Company Seabright Insurance Company Countersigned By WC 04 03 06 / (Ed. 4-84) ©1998 by the Workers' Compensation Insurance RaUng Bureau of California. All rights reserved. 2511