ONYX PAVING COMPANY, INC. (LOCAL STREET MAINTENANCE PROJECT FY 22-23)

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A� a® CERTIFICATE OF LIABILITY INSURANCE DA75/4/2023yy 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 Ileu of such endorsement(s). PRODUCER Burnham WGB Insurance Solutions CA Insurance License OF69771 15901 Red Hill Avenue CONTACT NAME: Michael Tran PNGNE 714-824-8384 Nc No:714-573-1770 EDBAIL ases, michael.tran@wgbib.com Tustin CA92780 INSURERS AFFORDING COVERAGE NAIC# INSURERA: American Zurich Insurance Company 40142 L'cense#: OF69771 INSURED ONYXPAV-01 OnyxCompany, INC. 2890 E. La 2890 E. La Cresta Avenue INSURERS: Zurich American Insurance Company 16535 INSURERC: Scottsdale Insurance Company 41297 INSURER D : Anaheim CA 92806-1816 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 257477163 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR rypE OF ADDLSUBR POLICYNUMBER POLICY EFF IMMIDDfYYYYI POLICY EXP (MMIDDMWILIMITS C TCOMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR BCS2000426 3/14/2023 3/14/2024 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $100,000 MED EXP (Any one person) $ Excluded PERSONAL &ADV INJURY $2,000,000 AGGREGATE LIMIT APED ES PER: POLICY [X] jEa F7 LOG GENERAL AGGREGATE $4,000,000 GENT PRODUCTS - COMP/OP AGG $4,000,000 $ OTHER: A I AUTOMOBILE LIABILITY BAP106300604 10/l/2022 10/1/2023 COMBINED SINGLE LIM[T Ea accident $2,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par ax) accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN WG106300504 10/1/2022 10/1/2023 X PER �RH E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED9 ❑ NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yas, describe under DE Ins,OF OPERATIONS below E.L. DISEASE-POLICYLIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, maybe aHached If more space Is required) Certificate holders) is/are named as additional insured per the attached endorsements as required by written contract subject to the terms & conditions of the policy: GL Additional Insured Farm #CG 20 10 12 19 and CG 20 37 12 19 GL Additional Insured State -Permits Form #CG 20 12 12 19 GL Primary and Non -Contributory Form #CG 20 01 12 19 GL Waiver of Subrogation Form #CG 24 04 12 19 GL Per Project Form #GLS-332s 01 12 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD