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PROOF OF INSURANCE (2021) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER EdgWcod' Partners Insurance Center P.O. Box 5003 San Ramon, CA 94583 Nww.eplCDrOKers.com INSURED All American Asphalt P.O. Box 2229 Corona CA 92878 COVERAGES CA LICENSE #01329370 CERTIFICATE NUMBER: 60509240 INSURER E : t4MU oRnm * 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 ADDLSUBR POLICY EFF POLICY EXP TR TYPE OF INSURANCEJum POLICY NUMBER MM8 D YYY ROO YY LIMITS A COMMERCIAL GENERAL LIABILITY DPC1005856-04 8/1/2020 8/1/2021 EACH OCCURRENCE $1.00Q000 ._ CLAIMS -MADE OCCUR DAM... PREMISES (Ea coaurrence),,,,,GE TO RENTED $ OQ OOQ, ......................_. MED EXP (Any one person) $ ... PERSONAL & ADV INJURY $ 1, OOO OOO _ _....-.,...,...�....a_ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY I. ✓ . JE C LOC PRODUOTS - COMP/OPnAGG $ 2 000 0QO ...... -" .._.. -..... ......._................. OT'ktiER° $ B AUTOMOBILE LIABILITY BAP5571088-08 8/1/2020 8/1/2021 ��lD�WNGLE�M� a tn�Innnuunnnn0 $2000 ._Y�. ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY : AUTOS BODILY INJURY (Per accident) $ P'RC}PERTY DAMAGE $ HIRED NON -OWNED ✓ ,''.. AUTOS ONLY ✓ '.,. AUTOS ONLY .2 er e, i+„I:q??.; , ............... C UMBRELLA LIAB '.00CUR TUE347483600 8/1/2020 8/1/2021 EACH OCCURRENCE $5000000 ✓ EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,00Q 000 Following -Form $ DED ✓ RETENTION $10,000 B WORKERS COMPENSATION WC593205707 8/1/2020 8/1/2021 ✓ TEAR.TUT OTRH- AND EMPLOYERS' LIABILITY YIN , _-- OFFICE /MEMB R/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 N / A E.L, EACH ACCIDENT _,,...,$ (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ QQUQQ ..____-__ ..'..., ... If yes, describe under DESCRIPTION OF OPERATIONS below E..L. DISEASE - POLICY LIMIT 1 $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PW 21-01 / RE: 2020-21 Pavement Rehabilitation Project / Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Clty of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo CA 90245 AUTHORIZED REPRESENTATIVE Certificates De artment ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 60509240 120 [Oil Standard with S5mm XS I Maritza Omelas 1 3/4/2021 5:03:18 PM (PST) I Page I of I I EPICI PO Box 5003 San Ramon, CA 94583 Phone: 925.244.7700 Fax: 925.901-0244 Email: EPICcerts@epicbrokers.com CERTIFICATE HOLDER: City of El Segundo 350 Main Street El Segundo CA 90245 To: Whom it may concern Regarding: Notice of Cancellation Date Issued: 3/4/2021 Named Insured(s): All American Asphalt Policy Number(s): DPC1005856-04 BAP5571088-08.�,,, WC593205707 TUE347483600 Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the above referenced Certificate Holder; except, 10 days notice for non-payment of premium. Sincerely, Z> 4---, Dan Ryan, Managing Principal epicbrokers.com edgewood partners insurance center ca license OB29370 60509240 120 [01) Standard with $5mm XS I Maritza Omelas 1 3/4/2021 5:03:18 PM (PST) I Page 2 of I I COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR. CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following, COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organiation(s). Any person or organization where the Named Insured has agreed to add as an additional insured by written contract or agreement, provided the contract or agreement is executed prior to any "occurrence" or offense Information required to complete this Schedule, if not Location(s) Of Covered Operations Any location where required by written contract or agreement, provided the contract or agreement is executed prior to any "occurrence" or offense. shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is broader than that which you are amended to include as an additional required by the contract or insured the person(s) or organization(s) agreement to provide for such shown in the Schedule, but only with additional insured. respect to liability for "bodily injury", "property damage" or "personal and B. With respect to the insurance afforded to advertising injury" caused, in whole or in these additional insureds, the following part, by: additional exclusions apply: 1. Your acts or omissions; or This insurance does not apply to "bodily injury" or "property damage" occurring 2. The acts or omissions of those after: acting on your behalf; 1. All work, including materials, parts in the performance of your ongoing or equipment furnished in operations for the additional insured(s) at connection with such work, on the the location(s) designated above. project (other than service, maintenance or repairs) to be However: performed by or on behalf of the additional insured(s) at the location 1. The insurance afforded to such of the covered operations has been additional insured only applies to completed; or the extent permitted by law; and 2. That portion of "your work" out of 2. If coverage provided to the which the injury or damage arises additional insured is required by a has been put to its intended use by contract or agreement, the any person or organization other insurance afforded to such than another contractor or additional insured will not be subcontractor engaged in CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 60509240 120 [01 ] Standord with S5mm XS I Maritza Omelas 1 3/4/2021 5:03:1 S PM (PST) I Page 3 of I 1 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 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: All other terms and conditions of this policy remain unchanged. 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. 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: DPC1005856-04 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2020 REFERENCE: PW 21-01 / RE: 2020-21 Pavement Rehabilitation Project / CG20100413 SCHEDULE: City of El Segundo © Insurance Services Office, Inc., 2012 Page 2 of 2 60509240 120 [01 ] Standard with $5mm XS I Maritza Omelm 13/4/2021 5:03: I9 PM (PST) I Page 4 of I I COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization where the Named Insured All locations where required by contract. has agreed to add as an additional insured by written contract or agreement, provided the contract or agreement is executed prior to any 'occurrence" or offense Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is additional insured. amended to include as an additional insured the person(s) or organization(s) B. With respect to the insurance afforded to shown in the Schedule, but only with these additional insureds, the following is respect to liability for "bodily injury" or added to Section III — Limits Of "property damage" caused, in whole or in Insurance: part, by "your work" at the location designated and described in the Schedule If coverage provided to the additional of this endorsement performed for that insured is required by a contract or additional insured and included in the agreement, the most we will pay on behalf "products -completed operations hazard". of the additional insured is the amount of insurance: However: 1. Required by the contract or 1. The insurance afforded to such agreement; or additional insured only applies to the extent permitted by law; and 2. Available under the applicable Limits of Insurance shown in the 2. If coverage provided to the Declarations; additional insured is required by a contract or agreement, the whichever is less, insurance afforded to such additional insured will not be This endorsement shall not increase the broader than that which you are applicable Limits of Insurance shown in required by the contract or the Declarations. agreement to provide for such CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 60509240 120 [01 ] Standard with S5mm XS 1 Maritza Omelas 13/4/2021 5:03:18 PM (PST) I Page 5 of I I 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: DPC1005856-04 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2020 REFERENCE: SCHEDULE: PW 21-01 / RE: 2020-21 Pavement Rehabilitation Project / City of El Segundo CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 60509240120 [01] Standard with SS= %S I Madtza Ornelas 1 3/4/2021 5:03:1 @ PM (PST) I Page 6 of 11 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY COI" TF IBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: All other terms and conditions of this policy remain unchanged. REFERENCE: PW 21-01 / RE: 2020-21 Pavement Rehabilitation Project / Endorsement Number: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. SCHEDULE: City of El Segundo 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: DPC1005856-04 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2020 CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 60509240 120 [01 ] Standard with S5mm XS I Maritza Ornelas 1 3/4/2021 5:03:1 B PM (PS) I Page 7 of I I COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization where the waiver of our right to recover is permitted by law and is required by written contract or agreement, provided the contract or agreement is executed prior to any occurrence or offense Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer for injury or damage arising out of your ongoing Of Rights Of Recovery Against Others To Us operations or "your work" done under a contract of Section IV — Conditions: with that person or organization and included in the "products -completed operations We waive any right of recovery we may have hazard". This waiver applies only to the person against the person or organization shown in the or organization shown in the Schedule above. Schedule above because of payments we make 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: DPC1005856-04 Named Insured:All American Asphalt Endorsement Effective Date: 08/01/2020 REFERENCE: SCHEDULE: PW 21-01 / RE: 2020-21 Pavement Rehabilitation Project I City of El Segundo CG24040509 © Insurance Services Office, Inc., 2008 Page 1 of 1 60509240 120 [01] Standard with S5mm XS I Marilza Omelas 13/4/2021 5:03:18 PM (PST) I Page 8 of I I 3/4/2021 POLICY NUMBER: BAP5571088-08 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage providod in tho Covorago Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2020 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule. if not shown above. will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 SCHEDULE: City of El Segundo © Insurance Services Office, Inc., 2011 Page 1 of 1 60509240 120 [01] Standard with S5rnm XS I Maritza Ornelas 1 3/4/2021 5:03:18 PM (PST) I Page 9 of 11 3/4/2021 POLICY NUMBER: BAP5571088-08 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF (RIGHTS OF RECOVERY AGAINST OTHERS TO CIS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER 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 Insured: All American Asphalt Endorsement Effective Date: 08/01/2020 SCHEDULE Name(s) Of Person(s) Or Organization(s): ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the SCHEDULE: person(s) or organization(s) shown in the Schedule, City of El Segundo but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 60509240 120 [oil Standard with $5mm XS I Moritz® Omelas 1 3/4/2021 5:03:18 PM (PST) I Page 10 of 1 I 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 0 .00 % of the California workers' compensation pre- mium otherwise due on such remuneration. Person or Organization ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION SCHEDULE: City of El Segundo Policy Number: WC593205707 Named Insured: All American Asphalt All American Asphalt Endorsement Effective Date: 08/01/2020 WC 252 (4-84) WC 04 03 06 (Ed. 4-84) Schedule Job Description ALL CA OPERATIONS REFERENCE: PW 21-01 / RE: 2020-21 Pavement Rehabilitation Project / Page 1 of 1 60509240 120 [01 ] Standard with S5mm XS I Maritza Ornelas 1 3/4/2021 5:03:18 PM (PST) I Page 11 of I I