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PROOF OF INSURANCE (2016) CLOSEDDATE (MM /DDIYYYY) w CERTIFICATE OF LIABILITY INSURANCE 8/17/2015 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 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). CONCT PRODUCER Patriot Risk & Insurance Services NAME 100 Spectrum Center Drive, Suite #400 PHONE FAX `�' Irvine, CA 92618^ ^siu........ /9a9; 486-7900 Aec No 9�t£t 486 7950 .. M_ .a t..... ..___------ IE -MAIL. INSURER(S) AFFORDING COVERAGE NAIC # www.patrisk,com OG55454 INSURERA: Valley Forge Insurance COmDanv 20508 .. _ m,,,.......... INSURED _ moanv 20443 Su erior Paving Corn any, Inc., D A tjliltOii Paving O Continental Casualty Co. Comoanv m._.m 25496 INSURERD Torus National Insurance 1880 N. Delilah St. INSURER CoronaCA 92879 �o ��.__ ...................... �..�.�.�.�.�.�.�............�.w .. �.�.�.�.. . ............................... - COVERAGES CERTIFICATE NUMBER: 260, 00176 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. TYPE OF INSURANCE .... .._ ... ... "..�. ,.. ..... ". .... .... .... GNSR POLICY Ei"#° MMD FXP UTR '... Pr]I ICY NUMBED MMFDDIYYYY MMIOO�PA"MYY LIMITS �,/n , ^ El Segundo CA 90245 A �+' COMMERCIAL GENERAL LIABILITY ✓^ 6014034661 .6/1/2015 6/1/2016 EACH OCCURRENCE $ 1,000,000''.. 4, E/] DTYaiA T rYt1 E0 .W .$..500000'.. CLAIMS -MADE .... OCCUR _PREMISE =S (y oor�nrrq;r ), MED EXP (Any one person) $ 15,000 _ PERSONAL &ADVINJURY $ 1,000,000'.. GENERAL AGGREGATE Is 2,000 000'.. GEN'L P AGGREGATE LIMIT APPLIES PER: .... P Ca ❑ LOC ..". - COMP /OP AGG ,,. $ _ 2 000 000 Or'HIER: ,PPROODUCTS Derty damaae IIab $ 5.000 deductible A AU AUTOMOBILE LIABILITY ✓ ✓ 5095056276 6/1/2015 6/1/2016 SINGLE tG "AB ED W &RAM N D SIN ILtlM%IT $ 1.000.000'. ANY AUTO BODILY INJURY (Per person) $ .....: ALL OWNED r SCHEDULED BODILY INJURY (Per accident) $ AUTOS _ AUTOS .. .. NON -OWNED HIREDAUTOS ✓'AUTOS . $ B UMBRELLA LIAB 509406 8719 6/112015 611/2016 EACH OCCURRENCE $ 9 000 000Polic 7�C�CUR Follows Form Over G .... EXCESS LIAB MADE'.. ( y AGGREGATE 9,000,000DED .. w_._— GL/AU/WC Policies) _, ..., ✓ RETENTION $10,000 1 Is C WORKERS COMPENSATION T10150036 6/1/2015 611/2016 1 CTGT ITF rp 'i AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E ACCIDENT $ L EACH ACC 1,000,000 OFFICER/MEMBER EXCLUDED? NIA — — (Mandatory inNH) DISEASE - EA EMPLOYEd $ E 1,000,000 '. 40'6' describe undor SCRIP`T*N OF OPERATIONS below '.... E.L. DISEASE - POLICY LIMIT $ ...... 1.000,000 '.... DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Contract # PW 15 -17, Asphalt work, Asphalt Repair in Alley Between El Segundo Blvd., and Franklin Ave. Parallel to Nevada Ae, And Center Street El Segundo, CA 90245 / Certificate Holder, its officials, and employees are named as Additional Insured as respects to General Liability & Auto Liability per the endorsement attached as required by written contract. Coverage is Primary & Non - contributory in regards to General Liability. Waiver of subrogation applies to General Liability, Auto Liability & Workers Compensation per attached endorsements. 30 -days notice of cancellation/ 10 -days for non - payment of premium. CERTIFICATE HOLDER CANCELLATION CIty Of El Se' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Undo EXPIRATION WILL BE DELIVERED IN 350 Main Street ffly ACCORDANCE WITH POLICY PROVISIONS. El Segundo CA 90245 AUTHORIZED REPRESENTATIVE w Leonard E. Ziminsky ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 26000176 1 15/16 GL /AU /OMB /WC I Brennan Russell 1 8/17/2015 3:53:06 PM (PDT) I Page 1 of 21 This certificate cancels and supersedes ALL previously issued certificates„ IS 6014034661 AFM Superior Paving Company, Inc,, G-18052-J DBA: United Paving Co. (Ed. 07.12) CONTRACTORS' GENERAL LIABILITY EXTENSION ENDORSEMENT It Is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. The changes this endorsement makes do not apply with respect to any coverage that has been excluded or amended by another endorsement attached to this policy. SCHEDULE Coverage Is summarized below. For particulars and limitations affecting each coverage, please refer to the corresponding policy provisions In the body of this endorsement. r-1. Additional Insureds for terminated or ended G-18652-1 (Ed, 07-12) Page I of 12 t® MA AU Rights Renrved. 26000176 1 15/16 GL/AU/UMB/WC I Brennan Russell 1 6/17/2015 3z53:06 PM (PDT} I Page 2 of 21 This certificate cancels and supersedes ALL previously issued certificates. 1. ADDITIONAL INSURED SECTION II — WHO IS AN INSURED Is amended to Include as an insured any person or organization (called additional insured) described In paragraphs A. through G. below whom you are required to add as an additional Insured on this policy under a. written contract or written agreement, provided the written contract or written agreement: 1. Is currently In effect or becomes effective during the term of this policy; and If. Was executed prior to the "bocilly Injury," "property damage " or "personal Injury and advertising Injury" for which the additional Insured seeks coverage.. However, we will not provide the additional Insured any broader coverage or any higher limit of insurance than the least that Is: a. The maximum permitted by law; b. Required In the written contract or written agreement; c. Afforded to you under this policy; or d. Described In the applicable paragraphs A. through G. below. A. Controlling Interest Any persons or organizations with a controlling Interest In you but only with respect to their liability arising out of: 1. Their financial control of you; or 2. Premises they own, maintain or control while you lease or occupy these premises. This Insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional Insured. B. Co -owner of Insured Premises A co -owner of a premises co -owned by you and covered under this Insurance but only with respect to the co- owner "s liability as co -owner of such premises. G- 18852,1 (Ed. 07.12) 2. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires, D. Lessor - Land An owner or other Interest from whom land has been leased by you but only with respect to liability, arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This Insurance does not apply to: 1. Any 'occurrence" which takes place after you cease to lease that land; or 2. Structural alterations, new construction or demolition operations performed by or on behalf of such additional Insured. E. Lessor - Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: This Insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises; or 2. Structural alterations, new construction or demolition operations performed by or on behalf of such additional Insured. F. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for such additional Insured„ C. Lessor - Equipment G. State or Governmental Agency or 1.. Any person or organization from whom Subdivision or Political Subdivisions yo>:r lease equipment, but only with respect to A state or governmental agency or subdivision liability for "bodlly Injury," "property damage " or political subdivision subject to the following or "personal and advertising Injury" caused, provisions: In whole or in part, by your maintenance, 1. This Insurance applies only with respect to operation or use of equipment leased to you the following hazards for which the state or by such person or organization. governmental agency or subdivision or political subdivision has Issued a permit or G- 18852,1 (Ed. 07 -12) authorization In connection with premises Page 2 of 12 Copyright, CNA AH Rights Reserved. 26000176 1 15/16 GL /AU /UMB /WC I Brennan Russell I B/17/2015 3:53:06 PM (PDT( I Page 3 of 21 This certificate cancels and supersedes ALL previously issued certificates.. L A�= you own, rent, or control and to which this Insurance applies: a. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, holstaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or b. The construction, erection, or removal of elevators; or c. The ownership, maintenance or use of any elevators covered by this In'su'rance. 2. This Insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has Issued a permit or authorization. 3. This Insurance does not apply to: a. "Bodily injury," "property damage" or "personal and adve5ising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury' or "property damage" Included within the "products - completed operations hazard" A governmental permit which requires you to add the governmental entity, as an additional Insured will trigger this Provision 1, as H the permit were a written contract. 2. BODILY INJURY — EXPANDED DEFINITION SECTION V — DEFINITIONS, the definition of "bodily injury" Is changed to read: "Bodily Injury" means bodily Injury, sickness or disease sustained by a person, including death, . humiliation, shook, mental anguish or mental Injury by that person at any time which results as a. consequence of the bodily injury, sickness or disease. 3. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE Condition 2. Duties In The Event of Occurrence, Offense, Claim or Suit of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS Is amended to add the following provisions: G- 19652,1 (Ed. 07 -12) You must give us or our authorized representative notice of an "occurrence," offense, claim, or "suit" only when the "occurrence," offense, claim or "suit" is known to: (1) You, If you are an Individual; (2) A partner, If you are a partnership; (3) An executive officer or the employee designated by you to give such notice, If you are a corporation,, or (4) A manager, If you are a limited liability company. B. NOTICE OF OCCURRENCE Your rights under this Coverage Part will not be prejudiced If you fail to give us notice of an "occurrence," offense, claim or "suit" and that failure Is solely due to your reasonable belief that the "bodily Injury" or "property damage" is not covered under this Coverage Part. However, you shall give written notice of this "occurrence," offense, claim or "suit" to us as soon as you are aware that this insurance may apply to such "occurrence," offense claim or "suit." 4. BROAD NAMED INSURED A. Any subsidiary or affiliate organization, other than a partnership, joint venture or limited liability company, in which a Named Insured specifically shown in the Declarations has management control, directly or through one or more subsidiary organizations, at the time of loss will qualify as a Named Insured but only 9 there is no other similar insurance available to such organization, nor similar insurance which would be available but for exhaustion of its limits. For the purpose of this provision, similar insurance means general liability or equivalent Insurance, no matter whether its coverage Is broader or narrower than that provided by this Insurance. But If the only other similar insurance is for a "consolidated (wrap -up) program," then a subsidiary that qualifies as a Named Insured on such project - specific insurance can still qualify as a Named Insured on this insurance, but not for projects covered by the "consolidated (wrap -up) program." [Please see Item 26.C. of this endorsement for the definition of "consolidated (wrap -up) program."] B. This endorsement does not apply to any organization for which coverage Is excluded by another endorsement attached to this policy. A. BROAD KNOWLEDGE OF OCCURRENCE G- 19652,1 (Ed. 07 -12) Page 3 of 12 Copydght, CNA AN Rights Reserved. 2600017E ( 15(15 GL(AU/UMB /WC I Flx:annan Ru ... 1:1. 1 0!7.7!2015 3:s:7206 PM (PDT) I Page n of 27. This certificate cancels., and supersede: ALL previ.ou ly :i.; ued certificates. i C. Only for the purpose of this endorsement: 1. Management control means: a. Ownership Interest representing more than 501% of the voting, appointment, or designation power for the subsidiary organization's governing body; or b. Having the right, pursuant to a written contract, or pursuant to the by -laws, charter„ operating agreement„ or similar document of a specifically shown Named insured or controlled subsidiary organization to select, appoint, or designate a majoftty of the subsidiary organization's governing body. Such contract or document must have been created prior to the time of lose; or c. Having the right, pursuant to a written trust agreement, to protect, control the use of, encumber or transfer and sell property held by a trust. 2. Governing body means the Board of Directors of a corporation. 3. Loss means: a. The occurring of the "bodily Injury" or "property damage "; or b. The committing of the offense that caused the "personal and advertising Injury." D. The Insurance provided by this policy applies to Named Insureds when trading under their own names, or under such trading names or doing - business -as (DBA) names as any should choose to employ. 5. BROADENED LIABILITY COVERAGE FOR DAMAGE TO "YOUR PRODUCT" AND "YOUR WORK" A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions Is amended to delete exclusions k. and I. and replace them with the following: [This insurance does not apply to:] k. Damage to Your Product "Property damage" to "your product" arising out of if" or any part of It except when caused by or resulting from: (1) Fire; (2) Smoke; (3) Collapse; or G-1 8852-J (Ed. 07-12) (4) Explosion. L Damage to Your Work "Property damage ", to "your work"" laing out of it, or any part of It and included In the "products - completed operations hazard." This exclusion does not apply: (1) If the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor; or (2) If the cause of loss to the damaged work arises as a result of: (a) Fire; (b) Smoke; (c) Collapse; or (d) Explosion. B. The following paragraph is added to SECTION III — LIMITS OF INSURANCE: Subject to S. above, $100,000 Is the most we will pay under Coverage A for the sum of damages arising out of any one "occurrence" because of "property damage" to "your product" and "Your work" that is caused by fire, smoke, collapse or explosion and is included within the "product - completed operations hazard." This sublimit does not apply to "property damage" to "your wont " if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. C. This Provision 5. Broadened Liability Coverage For Damage To "Your ProduoV And "Your Work" does not apply If an endorsement of the same name Is attached to this policy. 6. CONTRACTUAL LIABILITY — RAILROADS With respect to operations performed within 50 feet of railroad property, the definition of "Insured contract" in SECTION V — DEFINITIONS Is replaced by the following: "Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that Indemnifies any person or organization for damage by fire to premises while rented to you or temporarily oocupled by you with permission of the owner Is not an "Insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; G- 18852 -J (Ed. 07-12) Page 4 of 12 Copoght CNA AN Rights Reserve& 26000176 1 15(16 GL(AU(UMB /WC I Brennan Russell 1 8(17 {2015 3:53:06 PM (PDT) I Page 5 of 21 This certificate cancels and supersedes ALL previously issued certificates. d. An obligation, as required by ordinance, to Indemnify a municipality, except In connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an Indemnification of a municipality In connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily Injury" or "property damage" to a third person or organization. Tort liability means a liability that would be Imposed by law In the absence of any contract or agreement. Paragraph f. does not Include that part of any contract or agreement: (1) That Indemnifies an architect, engineer or surveyor for Injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that Is the primary cause of the injury or damage; (2) Under which the Insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the Insured's rendering or failure to render professional services, including those listed In (1) above and supervisory, inspection, architectural or engineering activities. 7. CONTRACTUAL LIABILITY FOR PERSONAL AND ADVERTISING INJURY Under SECTION I — COVERAGE B — PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions is amended to delete exclusion e. Contractual Liability. This provision 7. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 8. ELECTRONIC DATA LIABILITY A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion p. Electronic Data and replace It with the following: [This insurance does not apply to:) G- 18652 -J (Ed. 07 -12) Damages arising out of the loss of, lose of use of, damage to, corruption of, Inability to access, or Inability to manipulate "electronic data" that does not result frorh physical Injury to tangible property. However, this exclusion does not apply to liability for damages because of "bodily injury." B. The following paragraph Is added to SECTION III — LIMITS OF INSURANCE: Subject to S. above, $100,000 Is the most we will pay under Coverage A for all damages arising out of any one "occurrence" because of "property damage" that results from physical Injury to tangible property and arises out of "electronic data." C. The following definition Is added to the SECTION V — DEFINITIONS: "Electronic data" means Information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (Including systems and applications software), hard or floppy disks, CD -ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. D. For the purposes of the coverage provided by this endorsement, the definition of "property damage" In SECTION V — DEFINITIONS is replaced by the following: 17. "Property damage" means: a. Physical Injury to tangible property, Including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused It; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the °occurrence" that caused it; or c. Loss of, loss of use of, damage to, corruption of, inability to access, or Inability to properly manipulate "electronic data," resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this Insurance, 'electronic data" Is not tangible property. p. Electronic Data E. If Electronic Data Liability Is provided at a higher limit by another endorsement attached to this G- 18652 -J (Ed. 07 -12) Page 5 of 12 CopyrIght CNA All Rights Reserved, 26006176 1 15/16 GL /A[J /UMB /WC: 15rennasi Russell 1 0(17/2015 3:53:06 PM (PM I Page 6 of 21 This certificate cancels and supersedes ALL previously issued certificates, G-18662-J (Ed. 07-12) policy, then the $100,000 limit provided by this Intended Injury and replace it with the Provision 8. Electronic Data Usbillty Is part of, following: and not In addition to, that higher limit, [This Insurance does not apply to:) 9. EXPANDED PERSONAL AND ADVERTISING a. Expected or Intended Injury INJURY - DISCRIMINATION OR HUMILIATION A. SECTION V — DEFINITIONS Is amended to add the following to the definition of "Personal and advertising Injury": h. Discrimination or humiliation that results In Injury to the feelings or reputation of a natural person, but only If such discrimination or humiliation Is: (1) Not done Intentionally by or at the direction of: (a) The Insured; or (b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the Insured; and (2) Not directly or Indirectly related to the employment, prospective employment, past employment or termination of employment of any person or persons by any Insured. B. Under SECTION I — COVERAGE B — PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions Is mended to add the following additional xcluslons: [This Insurance does not apply to:] Discrimination Relating To Room, Dwelling or Premises "Personal or advertising Injury" caused by discrimination directly or Indirectly related to the sale, rental, lease or sub-lease or prospective sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured. Fines Or Penalties Fines or penalties levied or Imposed by a governmental entity because of discrimination. This provision 9. does not apply to any person or organization who otherwise qualifies as an additional Insured on this Coverage Part. 10. EXPECTED OR INTENDED INJURY "Bodily Injury" or "property damage" expected or Intended from the standpoint of the Insured, This exclusion does not apply to "bodily Injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 11. GENERAL AGGREGATE LIMITS OF INSURANCE - PER PROJECT A. For each construction project away from promises you own or rent, a separate Construction Project General Aggregate Limit, equal to the amount of the General Aggregate Limit, Is the most we will pay for the sum of: 1. All damages under Coverage A, except damages because of "bodily Injury' or "property damage" Included In the "products-completed operations hazard"; and 2. All medical expenses under Coverage C, that arise from "occurrences" or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shall not reduce the General Aggregate Limit shown In the Declarations, nor the Construction Project Aggregate Limit of any other construction project. B. All: 1. Damages under Coverage B, regardless of the number of locations or construction projects Involved; 2. Damages under Coverage A, caused by "occurrences" which cannot be attributed solely to ongoing operations at a single construction project, except damages because of "bodily Injury" or *property damage" Included In the "products - completed operations hazard"; and 3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a single construction project, Under SECTION I — COVERAGE A — BODILY will reduce the General Aggregate Limit shown INJURY AND PROPERTY DAMAGE In the Declarations. LIABILITY, Paragraph 2. Exclusions Is amended to delete exclusion a. Expected or G-18652-1 (Ed. 07-12) Page 6 of 12 C<Wdght, CNA All Rghts ResemW. 26000176 1 15/16 GL/AU/UMB/WC I Brennan Russell 1 8/17/2015 3z53z06 PM (PDT) I Page 7 of 21 This certificate cancels and supersedes ALL previously issued certificates, AWAL EM MILL- C. The limits shown In the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project Aggregate Limit or the General Aggregate Limit, depending on whether the "occurrence " can be attributed solely to ongoing operations at a particular construction project. D. When coverage for liability arising out of the "products- completed operations hazard" Is provided, any payments for damages because of "bodily Injury" or "property damage" Included In the "products- completed operations hazard," regardless of the number of locations Involved will reduce the Products - Completed Operations Aggregate Limit shown In the Declarations. E. If a single construction project away from premises owned by or rented to the insured has been abandoned and then restarted, or If the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. 12. IN REM ACTIONS Any action In rem against any vessel owned or operated by or for you, or chartered by or for you will be treated In the same manner as though the action were in personam against you. In rem is a term used to designate actions instituted against the thing, as distinct from actions against the person, which are said to be in personam. 13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE A. With respect only to "bodily injury" that arises out of a "health care incident," COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY OF SECTION I — COVERAGES is amended to replace Insuring Agreement Paragraphs 1.b.(1) and 1.b.(2) with the following: b. This Insurance applies to "bodily Injury" only It you are not In the business of providing professional health care services, and only It: (1) The "bodily Injury" Is caused by an "occurrence" that takes place in the "coverage territory." For the purpose of this Insurance: G- 18652 -J (Ed. 07 -12) Page 7 of 12 G- 18662 -J (Ed. 07 -12) (a) "Bodily Injury" caused by a "health care Incident" will be considered caused by an "occurrence "; and (b) All acts, errors or omissions that are logically connected by any common fact, circumstance, situation, transaction, event, advice or decision will be considered to constitute a single "occurrence "; (2) The "bodily Injury" occurs during the policy period. All "bodily Injury" arising from an "'occurrence" will be deemed to have occurred at the time of the first act, error, or omission that is part of the "occurrence "; and S. With respect only to the Insurance provided by this Provision 13., Exclusion 2.e. Employer's Liability of SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Is amended to append the following: Only for "bodily Injury" not covered by other liability Insurance (including state - sanctioned self insurance) available to the insured (or which would be available but for exhaustion of its limits), this exclusion does not apply to "bodily Injury" that arises out of a "health care Incident." C. SECTION V — DEFINITIONS Is amended to add the following new definition: "Health care Incident" means a negligent act, error or omission by your "employees" or "volunteer workers" working on your behalf in the rendering of or failure to render professional health care services in any of the following capacities, or the related furnishing of food, beverages, medical supplies or appliances: a. Physician; b. Nurse; c. Emergency medical technician; d. Paramedic; e. Chiropractor; f. Dentist; g. Athletic trainer; h. Audiologist; I. Physical therapist; j. Psychologist; k. Speech therapist; 1. Other allied health professional; or Copyright, CNA All Righb Roamed. 26000176 1 15/16 GL /AU /UMB /WC I Brennan Russel]_ 1 8/17/2015 3e53:06 PM (PDT) I Page 8 of 21 This certificate cancels and supersedes ALL previously issued certificates. I � � I. m. Provider of first aid or Good Samaritan services rendered in an emergency and for which no payment Is demanded or received. D. SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions Is amended to add the following additional exclusions. These new exclusions apply only to this Incidental Health Care Malpractice Coverage: [This Insurance does not apply to :] Dishonesty or Crime Any dishonest, criminal or malicious act, error or omission. Clinical Trials / Product Testing Acts, errors or omissions that occur in the course of human clinical trials or product testing. Medlcare/Medlcald Fraud Medicare or Medicaid fraud or abuse. Services Excluded by Endorsement Any "health care Incident" for which coverage Is excluded by endorsement. E. SECTION V — DEFINITIONS is amended to add the following subparagraph to Paragraph f. of the definition of "insured contract ": Paragraph f. does not include that part of any contract or agreement: (4) Under which you assume another's tort liability for "bodily injury" arising out of the rendering of or failure to render professional health care services. F. SECTION 11 — WHO IS AN INSURED Is amended to add the following provisions: 1. Your "employees" are insureds with respect to: a. "bodily Injury" to a co= employee" while In the course of the co- "employee's" employment by you or while performing duties related to the conduct of your business; and b. "bodily injury" to a "volunteer worker" while performing duties related to the conduct of your business; when such "bodily Injury" arises out of a "health care incident." 2. Your 'volunteer workers" are insureds with respect to: G- 18652 -J (Ed. 07 -12) Page 8 of 12 G- 18652 -J (Ed. 07 -12) a. "bodily Injury" to a co- "volunteer worker" while performing duties related to the conduct of your business; and b. "bodily Injury" to an "employee" while In the course of the "employee's" employment by you or while performing duties related to the conduct of your business; when such "bodily Injury" arises out of a "health care Incident." 3. Paragraphs 2.a. (1)(s), (b) and (c) of SECTION II — WHO IS AN INSURED do not apply to "bodily injury" for which Insurance Is provided this Provision 13. 4. Paragraph 2.a.(1)(d) of SECTION II — WHO IS AN INSURED is deleted. G. With respect to the Insurance provided by this Provision 13., the following Is added to Paragraph 4.1b.(1) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: To the extent this Insurance applies, it Is excess over any of the other insurance (Including qualified self Insurance), whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. 14. JOINT VENTURES / PARTNERSHIP / LIMITED LIABILITY COMPANIES A. The following Is added to SECTION II — WHO IS AN INSURED: 4. You are an Insured when you had an Interest In a joint venture, partnership or limited liability company which terminated or ended prior to or during this policy period, but only to the extent of your Interest in such joint venture, partnership or limited liability company. This coverage does not apply: a. Prior to the termination date of any joint venture, partnership or limited liability company; b. If there is other valid and collectible Insurance purchased specifically to insure the partnership, joint venture or limited liability company; or c. To a joint venture, partnership or limited liability company which Is or was Insured under a "consolidated (wrap -up) Insurance program." 26000176 1 15/16 GL /AU /UMB /WC I Brennan Russell 1 8/17/2015 3:53:06 PM (PDT) I Page 9 of 21 This certificate cancels and supersedes ALL previously issued certificates. 1� I [Please see Item 28.C. of this endorsement for the definition of "consolidated (wrap -up) program, "] B. The last paragraph of SECTION II — WHO IS AN INSURED Is deleted and replaced by the following: Except as provided under the Contractors' General Liability Extension Endorsement or by the attachment of another endorsement (If any), no person or organization Is an Insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that Is not shown as a Named Insured In the Declarations. 15. LEGAL LIABILITY /ALIENATED PREMISES/ BORROWED EQUIPMENT A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions Is amended to delete exclusion j. Damage to Property In Its entirety and replace It with the following: [This Insurance does not apply to:] j. Damage to Property "Property damage" to: (1) Property you own, rent, or occupy; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the Insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or Indirectly on your behalf are performing operations, If the "property damage" arises out of -those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was Incorrectly performed on it. Paragraph (2) of this exclusion does not apply if the premises are "your work." Paragraphs (3) and (4) of this exclusion do not apply to "property damage" to tools or equipment loaned to you. A separate limit of Insurance applies to such tools or equipment that are damaged while being used In your operations. G- 18652 -J (Ed. 07 -12) Page 9 of 12 G- 18652 -J (Ed. 07 -12) Paragraph@ (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises rented to you or temporarily occupied by you with the permission of the owner, or to the contents of premises rented to you for a period of 7 or fewer consecutive stays. A separate limit of Insurance applies to Damage To Premises Rented To You as described in SECTION III — LIMITS OF INSURANCE. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products- completed operations hazard." B. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE the last paragraph of Paragraph 2. Exclusions is deleted and replaced by the following. Exclusions o. through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner nor to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of Insurance applies to this coverage as described In SECTION III — LIMITS OF INSURANCE. C. The following paragraph is added to SECTION III — LIMITS OF INSURANCE: Subject to 5. above, $25,000 is the most we will pay under Coverage A for damages arising out of any one "occurrence" because of "property damage" to tools or equipment loaned to you by others that occurs while the equipment Is being used to perform operations. D. Paragraph 6. Damage To Premises Rented To You Limit of SECTION III — LIMITS OF INSURANCE is replaced by the following: 6. Subject to Paragraph 5. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most we will pay under SECTION — I — COVERAGE A for damages because of "property damage" to any one premises while rented to you or temporarily occupied by you with the permission of the owner, Including contents of such premises rented to you for a period of 7 or fewer consecutive days. The Damage To Premises Rented To You Limit is the greater of a. $500,000; or Copydghl, CNA AH FUghts Aesmed. 260001.76 1 1.5 /1.6 GL/AU/TM/WC I Hr.n,nan Russell 1 8/17/2015 1:51:06 PM (PUTT 1 page 10 0€ 21 This certificate cancels and supersedes ALL previously issued certificates. 1 7 _ b. The Damage To Premises Rented To You Limit shown In the Declarations, E. Paragraph 4,b.(1)(axll) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and replaced by the following: (IQ That is property Insurance for premises rented to you, for premises temporarily occupied by you with the permission of the owner; or for personal property of others in your care, custody or control; F. This Provision 16, does not apply If Damage To Premises Rented To You Liability under SECTION — 1 — COVERAGE A Is excluded by endorsement, 16. LIBERALIZATION CLAUSE If we adopt a change In our forms or rules which would broaden coverage for contractors under this endorsement without an additional premium charge, your policy will automatically provide the additional coverage as of the date the revision is effective In your state. 17. LIQUOR LIABILITY Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions Is amended to delete exclusion a. Liquor Liability. This provision 17. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 18. MEDICAL PAYMENTS A. Paragraph 7. Medical Expense Limit, of SECTION 111 — LIMITS OF INSURANCE is deleted and replaced by the following: 7. Subject to Paragraph 6. above (the Each Occurrence Limit), the Medical Expense Limit Is the most we will pay under SECTION — I — COVERAGE C for all medical expenses because of 'bodily Injury" sustained by any one person. The Medical Expense Limit is the greater of: (1) $15,000; or (2) The amount shown In the Declarations for Medical Expense Limit. B. Paragraph 1.a.(3Xb) of SECTION I — COVERAGE C MEDICAL PAYMENTS, is replaced by the following: (b) The expenses are Incurred and reported to us within three years of the date of the accident; and G-1 8652-J (Ed. 07 -12) Page 10 of 12 G- 18652 -J (Ed. 07 -12) This paragraph B. does not apply to medical expenses incurred in the state of Missouri. 19. NON -OWNED AIRCRAFT Under SECTION 1— COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions Is amended such that exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft you do not own, provided that: 1. The pilot In command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot; 2. The aircraft is rented to you with a trained, paid crew; and 3. The aircraft does not transport persons or cargo for a charge. 20. NON -OWNED WATERCRAFT Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions Is amended to delete subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft and replace it with the following. (This exclusion does not apply to:] (2) A watercraft you do not own that Is: (a) Less than 75 feet long; and (b) Not being used to carry persons or property for a charge. 21. PRIMARY AND NON - CONTRIBUTORY TO OTHER INSURANCE With respect to any person or organization that Is an additional insured under this Coverage Part, the following is added to Paragraph 4. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If you have agreed in writing in a contract or agreement that this Insurance is primary and non - contributory relative to an additional Insured's own Insurance, then this insurance is primary and we will not seek contribution from that other insurance. For the purpose of this Provision 21., the additional Insured's own insurance means Insurance on which the additional insured is a Named Insured. This Provision 21. does not apply In situations where the endorsement on this policy affording coverage to the additional insured specifies that this Insurance Is excess over any other Insurance available to that additional insured. 22. PROPERTY DAMAGE —ELEVATORS Y % CM Al Rights Reserved. 26000176 ( :1.5/3.6 GL/AU/UM/WC I Brennan Russell ( 0/17/2015 3:53:06 PM (PDTi I Page 11 of 20 This certificate cancels and supersedes ALL previcuely issued r_ertificatee. Air V/ A. Under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended such that exclusion k. Damage to Your Product, and subparagraph (3), (4) and (6) of exclusion j. Damage to Property do not apply "property damage' that results from the use of elevators. B. With respect only to the coverage provided by this endorsement, Condition 4. Other Insurance In SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following subparagraph b.(1)(a)(v): 4. Other Insurance b. Excess Insurance (1) This Insurance Is excess over: (a) Any of the other Insurance, whether primary, excess, contingent or on any other basis: (v) That Is Property insurance covering property of others damaged from the use of elevators. 23. SUPPLEMENTARY PAYMENTS A. Under Section I — Supplementary Payments — Coverages A and B, Paragraph 1.b., the limit of $250 shown for the cost of bail bonds Is replaced by $5,000: B. In Paragraph 1.d., the Ilmit of $250 shown for daily loss of earnings Is replaced by $1,000. 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 0 unintentionally you should fail to disclose all existing hazards at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. 25. WAIVER OF SUBGROGATION - BLANKET Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 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 any person or organization because of payments we make for Injury or damage arising out of: G- 18652 -J (Ed. 07.12) However, this waiver applies only when you have agreed In writing to waive such rights of recovery In a contract or agreement, and only 9 the contract or agreement: 1. Is In effect or becomes effective during the term of this policy; and 2. Was executed prior to lose. 26. WRAP -UP EXTENSION: OWNER CONTROLLED INSURANCE PROGRAM, CONTRACTOR CONTROLLED INSURANCE PROGRAM OR CONSOLIDATED (WRAP -UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project In the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a "consolidated (wrap-up) Insurance program" by applicable state statute or regulation: If the endorsement EXCLUSION — CONSTRUCTION WRAP -UP or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance Programs (C.C.I.P.) Is attached to this policy, then the following changes apply: A. The following wording is added to the endorsement: With respect to a "consolidated (wrap -up) Insurance program" project in which you are or were Involved, this exclusion does not apply to those sums you become legally obligated to pay as damages because of: 1. 'Bodily injury," 'property damage," or "personal or advertising Injury" that occurs during your ongoing operations at the project, or during such operations of anyone acting on your behalf; nor 2. "Bodily injury° or "property damage" Included within the "products - completed operations hazard" that arises out of those portions of the project that are not "residential structures." B. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS Is amended to add the following subparagraph 4.b.(1)(c) to Condition 4. Other Insurance: [This insurance is excess over:] (c) Any of the other insurance whether primary, 1. Your ongoing operations; or excess, contingent or any other basis that Is 2. "Your work" included in the "products completed Insurance available to you as a result of operations hazard." your being a participant in a "consolidated (wrap-up) insurance program," but only as G- 18652 -J (Ed. 07 -12) Page 11 of 12 pydght, CNA All RlghtB Reseived, 26000176 1 15/16 GL /AU /UPM /WC I Brennan Russell I 8/17/2015 3:53:06 PM (PLAT) I Page 12 of 21 This certificate cancels and supersedes ALL previously issued certificates. IF, L respects your Involvement In that 'consolidated (wrap-up) Insurance program." C. SECTION V — DEFINITIONS Is amended to add the following definition: "Consolidated (wrap-up) Insurance program" means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability Insurance covering some or all of the contractors or subcontractors Involved In the project, such as an Owner Controlled Insurance Program (O.C.I.P.) or Contractor Controlled Insurance Program (C.C,Lp.). "Residential structure" means any structure whore 30% or more of the square foot area Is used or Is Intended to be used for human All other terms and conditions of the Policy remain unchanged. G-18852-J (Ed. 07-12) residency Including but not limited to single or multifamily housing, apartments, condomInlums, townhouses, oo-operatives or planned unit developments and also Includes their common areas and/or appurtenant structures ( lncludlng pools, hot tube, detachedi garages u9st houses or any similar alructures),41hen there Is no Individual ownership of units, residential structure does not Include military housing, cottage /university housing or dormitories, long term care facilities, hotels, or motels, Residential structure also does not Include hospitals or prisons. This provision 26. does not apply to any person or organization who otherwise qualifies as an additional Insured on this Coverage Part. This endorsement, which forms a part of and Is for attachment to the Policy Issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date Is shown below, and expires concurrently with said Policy. G-18652-J (Ed. 07-12) Page 12 of 12 Material used with permission of ISO Properties, Inc CoPydghk CNA AN Rghts Raerved. 26000176 1 15/16 GL/AU/UMB/WC I Br.nn.. Russell. 8/17/2015 3:53:06 PM (PDTf I Page 13 of 21 This certificate cancels and supersedes ALL previously issued certificates. 6014034661 Superior Paving Company, Inc., DBA: United Paving Co. COMMERCIAL GENERAL LIABILITY CG 20 38 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured 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 under the 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 ends when your operations for the person or organization described in Paragraph 1. above are completed. rol B. With respect to the insurance afforded to these additional insureds, the following additional 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 "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional 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 location of the covered operations has been completed; or 26000176 1 15/16 GL /AU /UMB /WC I Brennan Russell 1 6/17/2015 3:53:06 PM (PDT) I Page 14 of 21 This certificate cancels and supersedes ALL previously issued certificates. Page 1 of 2 The most we will pay ♦ behalf of the additional insured is the amount of Insurance: 1. Required by the contract or agreement described in Paragraph A.1.; or IiUULML� 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. 26000176 1 15/16 1 Brennan Russell 1 8/17/2015 3z53z06 PM (PDT) I Page 15 of 21 This certificate cancels and supersedes ALL previously issued certificates. CG 20 38 0413 6014034661 Superior United ted Paving Pa ing Co, ny, Inc,, DMA: United P6viin� �d G- 140331 -D (Ed. 01/13) BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS — WITH PRODUCTS- COMPLETED OPERATIONS COVERAGE It Is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows* SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by 'written contract" per Paragraph A. below.) Loostlons of Covered Operations (As per the "written contract," provided the location Is within the "coverage territory" of this Coverage Part.) A. Section II - Who Is An Insured Is amended to Include as an additional Insured: 1. Any person or organization whom you are required by "written contract" to add as an additional Insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The Insurance provided to the additional Insured Is limited as follows: 1. The person or organization 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 the acts or omissions of those acting on your behalf, In the performance of your ongoing operations specified In the "written contract "; or b. "Your work" that Is specified in the "written contract" but only for "bodily Injury" or "property damage" Included in the "products - completed operations hazard," and only if: (1) The "written contract" requires you to provide the additional Insured such coverage; and (2) This Coverage Part provides such coverage. 2. It the "written contract" specifically requires you to provide additional Insurance coverage via the 10/01 edition of CG2010 (aka CG 2010 10 01), or via the 10101 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CO 20 10 11 86), then In paragraph B.I. above, the words 'caused In whole or In part by' are replaced by the words "arising out of. 3. We will not provide the additional insured any broader coverage or any higher limit of Insurance than: a. The maximum permitted by law; b. That required by the written contract"; c. That described in B.I. above; or d. That afforded to you under this policy, whichever is less. 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this Insurance Is excess of all other Insurance available to the additional insured whether on a primary, excess, contingent or G-140331-D, (Ed. 01/13) Page 1 of 2 fight CNA AU Rigft Flamm& 260007.76 ( 7.5/16 GL(AU(TYM /WC ( 5reman Russell ( 8/17(2015 3.53:06 PM (PDT) i Page 16 of 2:1. This certif:i.cate cancels and supersedes ALL Previously issued certificates. „7.11 G- 140331 -D (Ed. 01/13) any other basis. But It required by the "written contract” to be primary and non- contrlbutory, this insurance will be primary and non- contributory refative to Insurance on which the additional Insured Is a Named Insured, s. The Insurance provided to the additional insured does not apply to "bodily Injury," "property damage," or "personal and advertising Injury" arising out of: a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, Including: (1) The preparing, approving, or falling to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured Is specifically listed as an additional Insured on another endorsement attached to this Coverage Part. C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition Is amended to add the following additional conditions applicable to the additional insured: An additional Insured under this endorsement will as soon as practicable: (1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this Insurance, and of any claim or "sult" that does result; (2) Except as provided In Paragraph 8.4. of this endorsement, agree to make available any other Insurance the additional Insured has for a loss we cover Linder this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us In the Investigation, defense, or settlement of the claim or "auk "; and (4) Tender the defense and indemnity of any claim or "auk" to any other Insurer or $elf insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this Insurance to be primary and non - contributory, this provision (4) does not apply to insurance on which the additional Insured Is a Named Insured.. We have no duty to defend or Indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." D. Only for the purpose of the insurance provided by this endorsement, SECTION V — DEFINITIONS is amended to add the following definition: "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional Insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy; and 2. Was executed prior to: a. The "bodily Injury" or "property damage "; or b. The offense that caused the "personal and advertising injury," for which the additional Insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. Material used with permission of ISO Properties, Inc. G- 140331 -D (Ed. 01/13) Page 2 of 2 Copyright, CNA All Rights Reserved. 25000176 1 15/16 GL /AU /OMB /WC I 9—X—r R11Bn.11 I 8/17(2015 3:53 :.06 PM (PDT) I Page :17 o£ 21 Thin certificate cacxcel..s and aupereedes ALL previously :i.reued ceY't.i£icaC.ea 5095056276 �� Superior Paving Company, Inc., CNA83359XX DBA: United Paving Co. (Ed. 04/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS EXTENDED COVERAGE ENDORSEMENT BUSINESS AUTO PLUS - This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM 1. LIABILITY COVERAGE A. Who Is An Insured The following Is added to Section II, Paragraph A.i., Who Is An Insured: 1; a. Any Incorporated entity of which the Named Insured owns a majority of the voting stock on the date of Inception of this Coverage Form; provided that, b. The Insurance afforded by this provision A.I. does not apply to any such entity that is an 'Insured" under any other liability "policy" providing "auto" coverage. 2. Any organization you newly acquire or form, other than a limited liability company, partnership or joint venture, and over which you maintain majority ownership Interest. The Insurance afforded by this provision A.2.: a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form, or the next anniversary of its inception date, whichever is earlier. b. Does not apply to: (1) "Bodily Injury" or "property damage" caused by an "accident" that occurred before you acquired or formed the organization; or (2) Any such organization that is an "Insured" under any other liability "policy" providing "auto" coverage. 3. Any person or organization that you are required by a written contract to name as an additional! Insured Is an "Insured" but only with respect to their legal liability for acts or omissions of a person, who qualifies as an "insured" under Section 11 — Who Is An Insured and for whom Uabil'ity Coverage Is afforded under this policy. It required by written contract, this Insurance will be primary and non - contributory to insurance on which the additional Insured Is a Named Insured. 4. An "employee" of yours Is an "Insured" while operating an "auto" hired or rented under a contract or agreement In that "employee's" name, with your permission, while performing duties related to the conduct of your business. "Policy," as used In this provision A. Who Is An Insured, Includes those policies that were In force on the Inception date of this Coverage Form but: 1. Which are no longer in force; or 2. Whose limits have been exhausted. B. Ball Bonds and Lose of Earnings Section II, Paragraphs A.2. (2) and A.2. (4) are revised as follows: 1. In a.(2), the limit for the cost of bail bonds is changed from $2,000 to $5,000; and 2. In a.(4), the limit for the loss of earnings is changed from $250 to $500 a day. C. Fellow Employee Section II, Paragraph B.5 does not apply. Such coverage as Is afforded by this provision C. is excess over any other collectible Insurance. II. PHYSICAL DAMAGE COVERAGE A. Glass Breakage — Hitting A Bird Or Animal — Falling Objects Or Missiles The following Is added to Section III, Paragraph A.3.: With respect to any covered "auto," any deductible shown In the Declarations will not apply to glass breakage If such glass Is repaired, In a manner acceptable to us, rather than replaced. B. Transportation Expenses Section 111, Paragraph A.4.a. Is revised, with respect to transportation expense incurred by you, to provide: a. $60 per day, in lieu of $20; subject to b. $1,800 maximum, In lieu of $600. CNA Carpendon, 20M Page 1 of 3 ( ) Includes cMdahted Material of the Insumnoe Servkm 01ke used WM ft permiselan, 26000176 1 15/16 GL /AU /UM® /WC I Brennan Russell I 6/17/2015 3:53:06 PM (PDT) I Page 16 of 21 This certificate cancels and supersedes ALL previously issued certificates. Q� C. Lose of Use Expenses Section III, Paragraph A.4.b. Is revised, with respect to lose of use expenses Incurred by you, to provide; a. $1,000 maximum, In lieu of $600. D. Hired "Autos" The following Is added to Section 111. Paragraph A.: 5. Hind "Autos" If Physical Damage coverage Is provided under this policy, and such coverage does not extend to Hired Autos, then Physical Damage coverage Is extended to: a. Any covered "auto" you lease, hire, rent or borrow without a driver; and b. Any covered "auto" hired or rented by your "employee " without a driver, under a contract In that Individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. The most we will pay for any one "accident' or "loss" Is the actual cash value, cost of repair, cost of replacement or $75,000; whichever is less, minus a $500 deductible for each covered auto. No deductible applies to "loss" caused by fire or lightning. d. The physical damage coverage as Is provided by this provision Is equal to the physical damage coverage(s) provided on your owned "autos." a. Such physical damage coverage for hired "autos" will: (1) Include loss of use, provided it is the consequence of an "accident" for which the Named Insured is legally liable, and as a result of which a monetary loss is sustained by the leasing or rental concern. (2) Such coverage as is provided by this provision will be subject to a limit of $750 per "accident." E. Alrbag Coverage The following is added to Section III, Paragraph 111.3.: The accidental discharge of an alrbag shall not be considered mechanical breakdown. F. Electronic Equipment CNA033SOXX (Ed. 04/12) Section 111, Paragraphs 8.4.c and 8.4.d. are deleted and replaced by the following: a. Physical Damage Coverage on a covered hauto" also applies to ' "toss" to any permanently Installed electronic equipment Including Its antennas and other accessories. d. A $100 per occurrence deductible applies to the coverage provided by this provision. 0. Diminution In Value The following Is added to Section III, Paragraph 8.8.: Subject to the following, the "diminution In value" exclusion does not apply to: a. Any covered "auto" of the private passenger type you lease, hire, rent or borrow, without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b. Any covered "auto" of the private passenger type hired or rented by your "employee" without a driver for a period of 30 days or less, under a contract In that Individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. Such coverage as is provided by this provision Is limited to a "diminution In value" loss arising directly out of accidental damage and not as a result of the failure to make repairs; faulty or Incomplete maintenance or repairs; or the installation of substandard parts. d. The most we will pay for "loss" to a covered "auto" In any one accident is the lesser of: (1) $5,000; or (2) 20% of 'the "auto's" actual cash value (ACV). III. Drive Other Car Coverage — Executive Officers The following Is added to Sections II and III: 1. Any "auto" you don't own, hire or borrow Is a covered "auto" for Liability Coverage while being used by, and for Physical Damage Coverage while In the care, custody or control of, any of your "executive officers," except: a. An "auto" owned by that "executive officer" or a member of that person's household; or CNAOMOXX CopyrWht, CNA corporation, . Page 2 of 3 ( 04/12) InCludee coWahted t of ft Insurance ry h Its , 26000176 1 15/16 GL /AU /UMB /WC I Brennan Russell I 8/17/2015 3:53:06 PM (POT) I page 19 of 21 This certificate cancels and supersedes ALL previously issued certificates. b. An "auto" used by that "executive officer" while working In a business of selling, servicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as Is afforded by this provision. (1) Equal to the greatest of those coverages afforded any covered "auto "; and (2) Excess over any other collectible Insurance. 2. For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by -laws or any other similar governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described in this provision. IV. BUSINESS AUTO CONDITIONS A. Duties In The Event Of Accident, Claim, Suit Or Loss The following Is added to Section IV, Paragraph A.2.a.: (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. The following Is added to Section IV, Paragraph A.2.b.: (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or If you are not an individual, to any of your executive officers or partners or your Insurance manager. B. Transifer Of Rights Of Recovery Against Others To Us CNA63358XX (Ed. 04/12) The following is added to Section IV, Paragraph A.S. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have, because of payments we mane for Injury or damage, against any person or organization for whom or which you are required) by written contract or agreement to obtain this waiver from us. This Injury or damage must arise out of your activities under a contract with that person or organization. You must agree to that requirement prior to an "accident" or "loss." C. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph 0.2.: Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not Intentional. D. Other Insurance The following Is added to Section IV, Paragraph 8.5.: Regardless of the provisions of Paragraphs 5.a. and 6.d. above, the coverage provided by this policy shall be on a primary non - contributory basis. This provision Is applicable only when required by a written contract. That written contract must have been entered Into prior to "Accident" or "Loss." E. Policy Period, Coverage Territory Section IV, Paragraph B. 7.(5).(a). is revised to provide: a. 45 days of coverage In lieu of 30 days. V. DEFINITIONS Section V. Paragraph C. Is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, Including mental anguish, mental injury or death resulting from any of these. t, CNA CarpaWor% 2000. Page 3 of 3 ( ) Indudes copyflghted mate dal d the Insumnoe Swim ORA umW wo it 26000176 1 15/16 GL /AU /UMB /WC I Brennan Russell 1 8/17/2015 3:53:06 PM (PDT) I page 20 of 21 This certificate cancels and supersedes ALL previously issued certificates, 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 malntaln 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 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 pAIsmq which it Is attached and Is effective on the date Issued unless otherwise stated. (Me Information tlelow ulr ed only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective6/1/2015 . Policy N0.T10150035 Insured uperior paving Company, Inc., Insurance omp n Paving orus National Insurance Company Countersigned By WC 04 03 06 (Ed. 4-84) 01290 by the Waken' Compsn8Wl0n Insuranoe nalAip Bureau of Ca0lornla. A9 rtphts raprva& 26000176 1 15/16 GL /AU /UMB /WC I Brennan Russell I B/17/2015 3:53:06 PM (PDT) I Page 21 of 21 This certificate cancels and supersedes ALL previously issued certificates. Endorsement No. Policy Effective Date6/v2015