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PROOF OF INSURANCE (2021 - 2021) CLOSEDACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) I 12/23/2020 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 policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Joanne Cadarette InterWest Insurance Services PHONE FAX License #0601094 I (A/C. No. Extl: 916-609-8362 (A/C, No): 916-979-7562 P.O. Box 255188 I E-MAIL ADDREss: jcadarette@iwins.com Sacramento CA 95865-5188 I INSURER(S) AFFORDING COVERAGE NAIC # License#: OB010941 INSURERA: Financial Pacific Ins Company 31453 INSURED AMER I26 INSURER B: Arch Insurance Company 11150 American Asphalt South, Inc 14436 Santa Ana Avenue I INSURER C: Travelers Prop Cas Co of Amer 25674 Fontana CA 92337 I INSURER D: Westchester Surplus Lines Ins 10172 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1018372729 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY Y Y 60423382 12/31/2020 12/31/2021 EACH OCCURRENCE $2000000 CLAIMS -MADE � OCCUR X Contractual Liab X Ded.$5,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY � ECT 1:1 LOC OTHER: A AUTOMOBILE LIABILITY Y Y 60423382 X ANY AUTO OWNEDSCHEDULED DAMAGE TO RENTED AUTOS ONLY AUTOS X HIRED I X I NON -OWNED $ 100,000 AUTOS ONLY AUTOS ONLY MED EXP (Any one person) C X UMBRELLALIAB H OCCUR ZUP71M8933020 LAB LB CLAIMS -MADE $ 2,000,000 DED I X I RETENTION $ n GENERAL AGGREGATE B WORKERS COMPENSATION Y ZAWC19413903 AND EMPLOYERS' LIABILITY Y / N $ 4,000,000 ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? [--]N/A 12/31/2020 12/31/2021 (Mandatory in NH) $ 1,000,000 If yes, describe under fEa accident) DESCRIPTION OF OPERATIONS below D POLLUTION LIABILITY G70915613003 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Project #PW19-19, FY 18-19 Slurry Seal Project. Additional Insured Status applies if required by written contract per endorsement attached City of EI Segundo, its officers, officials, employees, agents, and volunteer. Per Project Aggregates applies to General Liability per the attached endorsement. Primary wording per attached endorsement. Waiver of Subrogation applies to General Liability, Automobile Liability and Workers Compensation per the attached endorsements. 30 day notice of cancellation, except 10 day notice for non-payment of premium applies per policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department Engineering Division 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 12/31/2020 12/31/2021 COMBINED SINGLE LIMIT $ 1,000,000 fEa accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ f Per accident) 12/31/2020 12/31/2021 EACH OCCURRENCE $6,000,000 AGGREGATE $ 6,000,000 4/1/2020 4/1/2021X I PER STATUTE EERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 8/27/2020 8/27/2022 LIMIT/EA OCC $2,000,000 LIMIT/AGG $2,000,000 DEDUCTIBLE $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Project #PW19-19, FY 18-19 Slurry Seal Project. Additional Insured Status applies if required by written contract per endorsement attached City of EI Segundo, its officers, officials, employees, agents, and volunteer. Per Project Aggregates applies to General Liability per the attached endorsement. Primary wording per attached endorsement. Waiver of Subrogation applies to General Liability, Automobile Liability and Workers Compensation per the attached endorsements. 30 day notice of cancellation, except 10 day notice for non-payment of premium applies per policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department Engineering Division 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy #60423382 COMMERCIAL GENERAL LIABILITY CG 20 21 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section 11 — Who Is An Insured is amended to in- clude as an insured any person(s) who are volunteer worker(s) for you, but only while acting at the direc- tion of, and within the scope of their duties for you. However, none of these volunteer worker(s) are in- sureds for: 1. "Bodily injury" or "personal and advertising injury": a. To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability com- pany), to your other volunteer worker(s) or to your "employees" arising out of and in the course of their duties for you; b. To the spouse, child, parent, brother or sister of your volunteer worker(s) or your "employees" as a consequence of Para- graph 1.a. above; c. For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs 1.a. or b. above; or d. Arising out of his or her providing or failing to provide professional health care serv- ices. 2. "Property damage" to property: a. Owned, occupied, or used by, b. Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your other volunteer workers, your "employees", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). CG 20 21 07 98 Copyright, Insurance Services Office, Inc., 1997 POLICY NUMBER: 60423382 COMMERCIAL GENERAL LIABILITY CG 25 03 03 97 FBI **4i kii 1 0 0 0 This endorsement modifies insurance provided under the following: SCHEDULE Designated Construction Projects: ALL PROJECTS WITH THE POLICY PERIOD. (if nnentry appears above, information required hzcomplete this endorsement will be shown inthe Declarations as applicable to this endorsement.) A, For all sums which the insured becomes legally obligated to pay as damages caused by "000urremoes"under COVERAGE A(5ECT|ON |). and for all medical expenses caused byacci- dents under COVERAGE C(SECTION V\^which can beattributed only tuongoing operations ata single designated construction project shown in the Schedule above: 1' Aseparate Designated Construction Project General Aggregate Limit applies toeach designated construction project, and that limit is equal tothe amount ofthe General Aggre- gate Limit shown in the Declarations 2. The Designated Construction Project General Aggregate Limit isthe most wewill pay for the sum of all danngQee under COVERAGE A,except damages because of"bodily irjury" or"property damage" included inthe "products -completed operations hazard", and for medical expenses under COVERAGE C regardless ofthe number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons ororganizations making claims or bringing "suits" 3. Any payments made under COVERAGE A for damages or under COVERAGE Cf0r medical expenses shall reduce the Desig- nated Construction Project General Aggre- gate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown inthe Decla- rations nor shall they reduce any other Des- ignated Construction Project General Aggre- gate Limit for any other designated construc- tionpnojmct shown imthe Schedule above. 4. The limits shown inthe Declarations for Each Occurrence, Fire Damage and Medical Ex- pense continue to apply. However, instead of being subject tothe General Aggregate Limit shown inthe Declarations, such limits will ba subject tothe applicable Designated Con- struction PnojgntGenera| Aggregate Limit. B. For all sums which the insured becomes legally obligated topay asdamages caused by '' occurrences" under COVERAGE A(SECTION 1), and for all medical expenses Caused by acci- dents under COVERAGE C (SECTION 1), which cannot beattributed only toongoing operations ata single designated construction project shown in the Schedule above: 1. Any payments made under COVERAGE A for damages Vrunder COVERAGE Cfor medical expenses shall reduce the amount available under the General Aggregate Limit or the Prod ucts-Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated CnnstmodonPnojen General Aggre- gate Limit, C. When coverage for liability arising out ofthe ''products-comp|etedopenaUonohazanj''ispro- vided.anypaymentsfordanmageabeoaueenf "bodily injury" or"property damage" included in the "prod ucts-comp|etedoperations 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. CG 2503 03 97 Copyright, Insurance Services Office. Inc_ 1996 Pame 1 of D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restated, 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 project. E. The provisions of Limits Of Insurance (SECTION 111) not otherwise modified by this endorsement shall continue to apply as stipulated. Pnrto 4 of 9 (nnvrinhf Insurance Services Office. Inc.. 1996 CG 25 03 03 97 CG 2417 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: RN & I & 1:4 063 Y-11 11110,404 1:9 :1-31111114 F-11 .9 SCHEDULE Designated Job Site: ALL JOBSITES (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect to operations performed for, or affecting, a Tort liability means a liability that would be Scheduled Railroad at a Designated Job Site, the imposed by law in the absence of any definition of "insured contract" in the Definitions section is contract or agreement. replaced by the following: Paragraph f. does not include that part of any 9. "Insured Contract" means: contract or agreement: a. A contract for a lease of premises. However, (1) That indemnifies an architect, engineer or that portion of the contract for a lease of surveyor for injury or damage arising out premises that indemnifies any person or of: organization for damage by fire to premises while rented to you or temporarily occupied by (a) Preparing, approving or failing to you with permission of the owner is not an prepare or approve maps, shop "Insured contract"; , drawings, opinions, reports, surveys, b. A sidetrack agreement; field orders, change orders or c. Any easement or license agreement; drawings and specifications; or d. An obligation, as required by ordinance, to (b) Giving directions or instructions, or indemnify a municipality, except in connection failing to give them, if that is the with work for a municipality; primary cause of the injury or damage; e. An elevator maintenance agreement; (2) Under which the insured, if an architect, f. That part of any other contract or agreement engineer or surveyor, assumes liability for pertaining to your business (including an an injury or damage arising out of the indemnification of a municipality in connection insured's rendering or failure to render with work performed for a municipality) under professional services, including those listed which you assume the tort liability of another in Paragraph (1) above and supervisory, party to pay for "bodily injury" or "property inspection, architectural or engineering damage" to a third person or organization. activities. CG 24 17 10 01 Q ISO Properties, Inc,, 2000 Page I of I *48006550* 11111111111111111111111111111111111111111111111111 Westchester A (:ItulA) Company ADDITIONAL INSURED ENDORSEMENT — ONGOING WORK OR OPERATIONS Named Insured Endorsement Number American Asphalt South, Inc. Policy Symbol Policy Number Policy Period Effective Date of Endorsement CPW G70915613 003 8/27/2020 To 8/27/2022 ( 8/27/2020 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE: T+6,Wt(a 00 1. C1m;gl>.$rx&N.�l As required by written contract or agreement signed by both parties prior to a loss to which this insurance applies. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the persons or organizations shown in the Schedule, but only with respect to liability for injury or damage, to which this insurance applies, caused, in whole or in part, by: i. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insureds. However: t. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and 2. If coverage 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 provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: Exclusions This insurance does not apply to injury or damage occurring after: a. All work or operations, including materials, parts or equipment furnished in connection with such work or operations, on the project (other than service, maintenance or repairs) to be performed by you or on your behalf at the site of the covered operations has been completed; or ENV -3250 (12/18) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page t of 2 (221012.1) I Westchester A G E OA) Q;PumYaaq 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 organization other than another contractor or subcontractor engaged in performing operations for the additional insured as a part of the sameproject. C. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III — LIMITS OF INSURANCE: If coverage 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. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. ENV -3250 (12/18) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 2 of R (221012.1) HAesichester A Chubb Company ADDITIONAL INSURED ENDORSEMENT — PRODUCTS -COMPLETED OPERATIONS HAZARD Named Insured American Asphalt South, Inc. Endorsement Number Policy Symbol Policy Number Policy Period _....w._w Effective Date of Endorsement CPW G70915613 003 8/27/2020 To 8/27/2022 8/27/2020 Issued By (Name of Insurance Company) _ .— Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE '. wa',anara°C�rsarepiattg'it,r_aW;, As required by written contract or agreement signed by both parties prior to a loss to which this insurance applies. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. SECTION II — WHO IS AN INSURED 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 injury or damage, to which this insurance applies, caused by or resulting from your work performed for that additional insured and included in the products -completed operations hazard, and only to the extent that such injury or damage is caused, in whole or in part, by your negligence or the negligence of those acting on your behalf. However: i. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage 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 provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III - LIMITS OF INSURANCE: If coverage 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. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. ENV -3251 (12/18) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 (221012.2) Westchester A Cintl,h Q;e79RGia:lny" PRIMARY AND NONCONTRIBUTORY — OTHER INSURANCE CONDITION Named Insured Endorsement Number American Asphalt South, Inc. Policy Symbol Policy Number Policy Period Effective Date of Endorsement CPW G70915613 003 8/27/2020 To 8/27/2022 8/27/2020 ..—... . . . ................. Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACT'OR'S POLLUTION LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary and Noncontributory Insurance This policy is primary to, and will not seek contribution from, any other insurance available to an additional insured under this policy, provided that: a. The additional insured is a named insured under such other insurance; and b. The named insured has agreed in a written contract or agreement that this insurance would: (1) act as primary insurance; and (2) would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of this policy remain unchanged. ENV -3253 (12-18) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 (266562.2) WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Named Insured Endorsement Number American Asphalt South, Inc. Policy Symbol Policy Number Policy Period Effective Date of Endorsement CPW G70915613 003 8/27/2020 To 8/27/2022 8/27/2020 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Oroanization: Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: 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 ongoing operations or your work done under a contract with that person or organization and included in the products -completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same. ENV -3143 (03-05) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 POLICY NUMBER: 60423382 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Re: Project #PW19-19, FY 18-19 Slurry Seal Project. Additional Insured Status applies if required by written contract per endorsement attached City of EI Segundo, its officers, officials, employees, agents, and volunteer. Per Project Aggregates applies to General Liability per the attached endorsement. Primary wording per attached endorsement. Waiver of Subrogation applies to General Liability, Automobile Liability and Workers Compensation per the (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization is held liable for "your work" for that person or organization by or for you. This endorsement applies to the following work: Description of Job: see Above Location of Job: see Above Al only Effective from: Effective Date: 12/31/2020 Expiration Date: 12/31/2021 When this endorsement applies, such insurance as is afforded by the general liability policy is primary and any other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. CG 20 10 11 85 Modified (07-01) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: 60423382 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Re: Project #PW19-19, FY 18-19 Slurry Seal Project. Additional Insured Status applies if required by written contract per endorsement attached City of EI Segundo, its officers, officials, employees, agents, and volunteer. Per Project Aggregates applies to General Liability per the (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 POLICY NUMBER: 60423382 ASDA AU 07 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE NAMED INSURED: American Asphalt South, Inc 14436 Santa Ana Avenue Fontana CA 92337 ADDITIONAL INSURED: Re: Project #PW19-19, FY 18-19 Slurry Seal Project. Additional Insured Status applies if required by written contract per endorsement attached City of EI Segundo, its officers, officials, employees, agents, and volunteer. Per Project Aggregates applies to General Liability per the attached endorsement. Primary wording per attached endorsement. Waiver of Subrogation applies to General Liability, Automobile Liability and Workers Compensation per the attached endorsements. 30 day WHO IS AN INSURED (SECTION II) is amended to include as an insured the organization shown in the Schedule above, but only with respect to the operation of vehicles owned by the named insured and operated on behalf of the named insured. This endorsement does not apply to any operations for other than the named insured. Each person or organization named above is an insured for liability coverage, but only to the extent that person or organization qualifies as an insured under the Who Is An Insured provision of Section II Liability Coverage. The additional insured is not required to pay for any premiums stated in the policy or earned from the policy. Any return premium, if applicable, declared by us shall be paid to you. You are authorized to act for the additional insured in all mailers pertaining to this insurance. We will mail the additional insured notice of any cancellation of this policy. If the cancellation is by us, we will give thirty days notice to the additional insured. The additional insured will retain any right of recovery as a claimant under this policy. ASDA AU 07 01 Page 1 of 1 POLICY NUMBER: 60423382 ASDA AU 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE Name of Person or Organization: Re: Project #PW19-19, FY 18-19 Slurry Seal Project. Additional Insured Status applies if required by written contract per endorsement attached City of El Segundo, its officers, officials, employees, The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV BUSINESS AUTO CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above be- cause of payments we make for bodily injury or property damage arising out of losses or accidents which occur during the policy period. This waiver applies only to liability you assume pursuant to a contract with the person or organization shown in the schedule. ASDA AU 07 02 Page 1 of 1 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception dob* of the policy unless o different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 13/33/3030 at 12:01 A.M. standard time, forma o part of Policy No. ZAWC19413903 Endorsement No. of the Arch Insurance Company issued to American Asphalt South, Inc Premium (if any) $ 4 -1/111, -. Authorized Representative We have the right to recover our payments from anyone liable for on 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 nauonda ouuunaba|y segregating the remuneration ofyour employees while engaged in the work described in the Schedule. The additional premium for this endorsement aho|| be °96 of the California workers' compensation premium otherwise due onsuch remuneration. Schedule Person or Organization Job Description ALL PERSONS ANO/OR ORGANIZATIONS THAT REQUIRE AWRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TOTHE ACCIDENT ORLOSS, THAT WAIVER OFSUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON ANO/OR ORGANIZATION WC 252 (4-84) wCU4U3U0(Ed. 4-84) Page of