ALL AMERICAN ASPHALT (LOCAL STREET PREVENTATIVE MAINTENANCE FY 23-24)

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AC 3 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDWYYY) 411.......----- 4/26/2024 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 CFRTIFICATE HOLDER. PORTANT: If thetrcertificate holder is an ADD TIO tel tF,'3' t /b a ITIONAL INSURED provisions or be endorsed. A U: . . I ,;y ED, subject to the tel T s d i o fhe i I ,-cel'Cal po cis may require an endorsement. A statement on Aga c M . W e• n confer rights to the certh cat holder in lieu such endorse ent(s). PRODUCER Angie /AC wed'o Certificates Department Edgewood `.rtners Insurance Center PHONE FAX P.O. Box 5003 Date: O / t5.1p 451-3200 (vc.No): 925-901-0671 n R O CA 45 3ICcerts a(�epicbrokers.com INSURER(S)AFFORDING COVERAGE NAIC# icm QJ,,ENSE# 0n Iy �r Al �pecialt Insurance Company 21199 �T. i'6. r� e y P Y INSURED INSURER B: Lunch American Insurance Company 16535 All American Asphalt P.O. Box 2229 INSURER C: Great American Insurance Company 16691 Corona CA 92878 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 79714219 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 TYPE OF INSURANCE ADDLO w POLICY NUMBER SUER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A ✓ COMMERCIAL GENERAL LIABILITY DPC100585607 8/1/2023 8/1/2024 EACH OCCURRENCE $1,000,000 CLAIMS-MADE �/ OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ✓ JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAP557108811 8/1/2023 8/1/2024 COMBINED NGLE LIMIT $ (Ea accident)SI 2,000,000 ✓ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) $ C UMBRELLALIAB ,/ OCCUR TUE347483603 8/1/2023 8/1/2024 EACH OCCURRENCE $5,000,000 ✓ EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED ✓ RETENTION$10,000 Following-Form $ _ B WORKERS COMPENSATION WC593205710 8/1/2023 8/1/2024 i STATUTE ERH AND EMPLOYERS'LIABILITY Y/N — ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERJMEMBEREXCLUDED7 N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project#24-6907/RE:Local Street Preventative Maintenance FY 23-24/ Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation CERTIFICATE HOLDER CANCELLATION Cityof Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PRC\ Santa Ana CA 92701 Risk Management Division ; o N oR.,,,t a AUTHORIZED REPRESENTATIVE of 14 REVIEWED /y&APPROOVEDBY: 4 ot) I Maleah Cantrell '`r Risk Management Specialist k. ©1988-2015 ACORD / ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 79714219 123 [01] Standard with $5mm XS 1 Lisseth Medina 14/26/2024 10:52:32 AM (PDT) 1 Page 1 of 11