Item 20 - Agreements for On-Call Emergency Asphalt and Concrete Services

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ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 1 klk� 02/01/2023 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). PRODUCER CONTACT NAME: JEFF SCOTT Scott & McCauley Insurance Agency LLC HE AICONNo, EXt : 609-903-1562 AIC No 30585 Via Lindo5a ADDRESS: Jeff@SMinsuranceagency.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: NATIONAL FIRE INSURANCE COMPANY OF HARTFORD 20478 Laguna Niguel CA 92677 INSURED INSURERB: TRANSPORTATION INSURANCE COMPANY 20494 INSURER C: THE CONTINENTAL INSURANCE COMPANY 35289 EBS GENERAL ENGINEERING, INC INSURER D : VALLEY FORGE INSURANCE COMPANY 20508 1345 QUARRY ST STE 101 INSURER E : INSURER F : CORONA CA 92879 COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR $2,000 DEDUCTIBLE Y Y 7018007493 02/01/2023 02/01/2024 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 100,000 X MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY N JECTPRO ❑ LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS �( NON -OWNED AUTOS Y Y 7018007509 02/01 /2023 02/01 /2024 (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X Per accident $ C X UMBRELLA LAB EXCESS LAB X OCCUR CLAIMS -MADE Y Y 7018007526 02/01/2023 02/01/2024 EACH OCCURRENCE $ 7,000,000 AGGREGATE $ 7,000,000 DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑Y (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A Y 7034507011 09/28/2022 09/28/2023 X - STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Contractors Equipment (Scheduled) 7018009485 02/01/2023 02/01/2024 $1,749,500 C Contractors Equipment (Leased & RentE 7018009485 02/01/2023 02/01/2024 $400,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Blanket Additional Insured as required by an executed written contract or agreement on the General Liability, Auto Liability and Umbrella policies. Coverage is Primary & Non -Contributory where required by written contract or agreement with the named insured. Blanket Waiver -of -Subrogation is granted in favor of the Additional Insureds with respects to the General Liability, Auto Liability, and Workers Compensation policies. Thirty (30) days' notice of cancellation with ten (10) days' notice for non- payment of premium is provided. The Certificate Holder is listed as Loss Payee per written contract or agreement in regards to the Contractors Equipment policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Insurance' ACCORDANCE WITH THE POLICY PROVISIONS. AUTHHO!RIZED REPRESENTATIVE z livy © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD