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DATE(MM/DD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 01/29/2024 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Accounts Team <br /> NAME: <br /> Scott&McCauley Insurance Agency PHONE (g49)503-1953 FAX <br /> AIC No Ext: A/C,No): <br /> 2 Ritz Carlton Drive E-MAIL coi@sminsuranceagency.com <br /> ADDRESS: <br /> Suite 204 URER(§)AFFORDI11 C VERAG NAI # <br /> Dana Point 0 C 9 9 °UR d i3 1 SI r fw p f 1e m V� <br /> INSURED V,11 <br /> ti 6B: Trans p rt ti I sur e o a y I ZI <br /> 194 <br /> E E E$41 I IN ,IN URWP •C as r ce p — 289 <br /> 1345 QUARRY ST STE 101 INSURER D: Valley Forge Insurance Company 20508 <br /> Suite 101 <br /> INSURER E <br /> CORONA CA 92879 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: EBS Gen-2024-25 REVISION NUMBER: <br /> THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MM/DD YYYYMPOLICY EFF O DD YYYY LIMITS <br /> ICY EXP <br /> LTR INSD WVD <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE_7CLAIMS-MADE �OCCUR PREM SESOEa occu«Dence $ 100,000 <br /> X $2,000 Deductible MED EXP(Any one person) $ 15,000 <br /> A Y Y 7018007493 02/01/2024 02/01/2025 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO ❑ 2,000,000 <br /> JECT LOC PRODUCTS-COMP/OPAGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> X ANYAUTO BODILY INJURY(Per person) $ <br /> B OWNED SCHEDULED Y Y 7018007509 02/01/2024 02/01/2025 BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 7,000,000 <br /> C EXCESSLIAB CLAIMS-MADE Y Y 7018007526 02/01/2024 02/01/2025 AGGREGATE $ 7,000,000 <br /> DED I I RETENTION$ 1 $ <br /> WORKERS COMPENSATION X1 <br /> SPER TATUTE EORH <br /> AND EMPLOYERS'LIABILITY Y/N 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> D OFFICER/MEMBER EXCLUDED? F NIA Y 7034507011 09/28/2024 09/28/2025 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Contractors Equipment <br /> C 7018009485 02/01/2024 02/01/2025 Leased&Rented Equip $400,000 <br /> Owned/Scheduled Equip $1,579,500 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> EBS#23105 <br /> On-Call Asphalt&PCC Agreemen <br /> Blanket Additional Insured as required by a written contract or agreement on the General Liability,Auto Liability,and Umbrella policies.Coverage is Primary& <br /> Non-Contributory where required by a written contract or agreement with the named insured.Blanket Waiver-of-Subrogation is granted in favor of the <br /> Additional Insureds with respect to the General Liability,Auto Liability,and Workers Compensation policies.Thirty(30)days'notice of cancellation with ten <br /> (10)days'notice for non-payment of premium is provided.The Certificate Holder is listed as a Loss Payee per written contract or agreement in regards to the <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> City of Santa Ana ACCORDANCE WITH THE POLICY PRO) <br /> 20 Civic Center Plaza Risk ManaganentDiMslan <br /> AUTHORIZED REPRESENTATIVE ' REVIEWED br APPROVm BY. <br /> Santa Ana CA 92702 <br /> ® Risk Management Specialist <br /> ©1988-2015 ACOF <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />