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PROOF OF INSURANCE (2022) CLOSEDDATE (MM/DDIYYYY) ACC>R"CERTIFICATE OF LIABILITY INSURANCE t. r 712312021 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 Edgetr�D�ad Partners Insurance Center CONTACT ­111^^ NAME; Certificates Department P„O. OX 5003 tPHONE nlc NaJ 925 901-0671 San Ramon, CA 94583 EPNC _.925-244-7700 E MAtL ^ AAATL e i tarn& Ismcom COVERAGE ...,...,. ......................................... NAIC.#.............. www.epicbrokers.com CA LICENSE #0629370 INSURER A : ArchmSpeclaltv Insurance Company y „ 21199 INSURED R B Zurich American Insurance Com an _. _ 16535 _ INSURER �! ..�.. All American Asphalt IT_"_mITITm" .. INSURER c : Great American Insurance Company 16691 P.O. BOX 2229 Corona CA 92878 JNSURER D INSURER E INSURER F rnvCOArCQ r`CDTIUlf`ATC IVIIRA911=0• n�n4n4oc RFVISIr]N NI IMHFH' 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. ........� INS'FC TYPE OF INSURANCE POLICY NUMBER....;V ��Ih"EY MMIi._._._ .,,,m,. __ ..... .....__�.---- LTR. CY EXP LIMITS DDM YY A +" COMMERCIAL GENERAL LIABILITY DPC100585605 8/1/2021 8/1/2022 EACHOCCURRENCE 1,$1.000,000 _ RFMI„ 100 000 CLAIMS -MADE OCCUR P SES lF3 gcrur ence, $„ ......__ wa.......................�.......�.. MED EXP (Any one person) ...PERSONAL&ADVINJURY $ ... ......_.. $1._ ,000,000 Gr:N"lL h43GREiATE: LIMIT APPLIES PER: GENERALAGGREGATEm .... s2,000,000 PRODUCTS,mm COMP/OP,AGG $2,000 000 OTn IER: $ B AUTOMOBILE LIABILITY BAP557108809 8/1/2021 8/1/2022 INEt3 WGL tl 'nQ COMB. eaac�af mm$ 2.000000...,.�_. ANY AUTO BODILY INJURY (Per person) _— OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED�4T1TrUF"ERTYt7AwlArr,.. I-,/— J.. .. $ AUTOS ONLYAUTOS ONLY Pev a`dn t1... �._ w-,... .... ...n„ $ C UMBRELLA ua6 ✓ OCCUR TUE347483600 8/1/2021 8/1/2022 NCE EACHOCCURRE mm $ 5 000,000 .... ITmm ✓ '.... EXCESS LIAB CLAIMS -MADE AGGREGATE .. ... ,000,OO( $ 5.e.,__— �....,,, ., DED ✓ RETENTION$10,000 Following -Form $ B WORKERS COMPENSATION WC593205708 8/1/2021 8/1/2022 L PE�TQLF OTH AND EMPLOYERS'LIABILITY"" YIN ANYPROPRIE-rOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,,000�..000 OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) NIA . �� E-L—DISEASE EA EMPLOYEE $ 11 "Q �QQQ If yes desoibe under DESCRIPTION OF OPERATIONS below E,L DISEASE - POLICY LIMIT $1 0000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 Cityy Of El Segundo 350 Fain Street El Segundo CA 90245 II LAHN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Certificates Department U 1988-ZU15 AGUKU GUKPUKA I IUN. All rlgnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 63016186 1 21 [011 Standard with $5mm XS I Seta He 1 7/23/2021 10:30:18 AM (PDT) I Page 1 of 11 E P I C PO Box 5003 San Ramon, CA 94583 Phone: 925.244.7700 Fax: 925.901-0244 Email: EPICcerts@epicbrokers.com CERTIFICATE HOLDER: City o1 El Segundo 350 Main Saxc°et El Segundo CA 90245 To: Whom it may concern Regarding: Notice of Cancellation Date Issued: 7/23/2021 Named Insured(s): All American Asphalt Policy Number(s): DPC100585605 BAP557108809 WC593205708 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:) a ---- Dan Ryan, Managing Principal epicbrokers.com ed ewood partners insurance center ca license OB29370 63016186 1 21 (Oil Standard with $5mm XS I Seta Ho 1 7/23/2021 10.30:18 AM (PDT) I Page 2 of 11 COMMERCIAL GENERAL LIABILITY CG20100413 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) Location(s) Of Covered Operations Or Organization(s): Any person or organization where the Named Any location where required by written contract or Insured has agreed to add as an additional insured agreement, provided the contract or agreement is by written contract or agreement, provided the executed prior to any "occurrence" or offense. 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 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 2, The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1„ The insurance afforded to such additional insured only applies to the extent permitted by law; and This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 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 location of the covered operations has been completed; or 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 63016186 121 [011 Standard with $5mm XS I Seta Ho 17/23/2021 10:30:18 AM (PDT) I Page 3 of 11 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: DPC100585605 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2021 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 1, „t..d+' d wIV.h I ,Seta. Ho ( P/23/2021. 10 30il.B AM (k?I'.T) I Page 4 of '1.11. 630161.86 21. 071.y �3'>nie� M".i COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OIL 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 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 endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. 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 1 1� 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. © Insurance Services Office, Inc., 2012 Page 1 of 2 63016106 1 21 [01) Standard with $5mm XS I Seta Ho 17/23/2021 10:30:10 AM (PDT) I Page 5 of 11 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: DPC100585605 Named Insured: All American Asphalt Endorsement Effective Date. 08/01/2021 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 63016.1..66 1 21 (01..1 Standard with $5ynrn XS I .Seta Ho 1 7/.23/202:1 1..0z30:,7..8 AM (PDT) I Page 6 of 1.1. COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MoiA w a l 1 02 1:43 OLIM I ILI R-14 11i :LIAr 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: DPC100585605 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2021 ® Insurance Services Office, Inc., 2012 Page 1 of 1 630361e6 1 21 foal standard with S5mm xs I seta Ho 1 7/23/2021 10:30:18 AM (PDT) I Page 7 of 11 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF'RIGHTS IGHTS OF RECOVERY AGAINST OTHERS TO IDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or 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 Of Rights Of Recovery Against Others To Us of Section IV — Conditions: 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 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: DPC100585605 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2021 PW 21-Ol / RE: 2020-21 Pavement Rehabilitation Project/ SCHEDULE: City of El Segundo © Insurance Services Office, Inc., 2008 Page 1 of 1 63016186 1 21 [01] Standard with $Smm xS I Seca Ho 1 7/23/2021 10:30:18 ww (PDT) I Page S of 11 POLICY NUMBER: BAP557108809 7/23/2021 COMMERCIAL AUTO CA20481013 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 provided in the Coverage 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:08/01/2021 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 Carder 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 aie.,i I z! Mij Standard with Min x,s I Seta No 1 7/23/2021 20: 30a 18 AM (PUN I Page 9 of n 7/23/2021 POLICY NUMBER: BAP557108809 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF FIGHTS OF E COVE RY 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: 08/01/2021 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 63616:1.86 1 21 [OS] Standard with $5mm XS I Seta No 1 7/2:3/2021 10n30.18 AM (PIXF) I Page 10 of: 11 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHTTO 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. Schedule Person or Organization Job Description ALL PERSONS AND/OR ALL CA OPERATIONS 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: REFERENCE: PW 21-01 / RE: 2020-21 Pavement Rehabilitation Project / City of El Segundo Policy Number: WC593205708 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2021 WC 252 (4-84) WC 04 03 06 (Ed. 4-84) Page 1 of 'I 6301618E 1 21 (01] Standard with $5M X:S I Seca Ho 17/23/2021 16:30.18 AM (PDT) I page 1. of 11