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A4C"J?6r CERTIFICATE OF LIABILITY INSURANCE
<br />llb�
<br />DATE(MM)DDIYYYY)
<br />3I4I2025
<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
<br />Edgewood Partners Insurance Center
<br />P.O. BOX 5003
<br />San Ramon CA 94583
<br />CONTACT
<br />Certificates Department
<br />PHONE FAx
<br />o E : 559A51-3200 fAIC. No): 925-901-0671
<br />ADDRess: EPICcerts@epicbrokers.com
<br />INSURER S AFFORDiNG COVERAGE
<br />NAIC p
<br />INSURERA: Arch SpecialtyInsurance Company
<br />21199
<br />Ucenae#: OB29370
<br />INSURED ALLAMER31
<br />All American Asphalt
<br />P.O. Box 2229
<br />INSURER B : Zurich American Insurance Company
<br />16535
<br />INSURERC: Great American Insurance Company
<br />16691
<br />INSURER D
<br />Corona, CA 92878
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:2073587077 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INqE1
<br />SUBR
<br />WVn
<br />POLICY NUMBER
<br />POLICY EFF
<br />IMMIDWYYYY
<br />POLICY EXP
<br />MMIDD)YYYY)LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE Fx_1 OCCUR
<br />DPC100565608
<br />8/1/2024
<br />811/2025
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />MED EXP (Any One person)
<br />$
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY [Z] PE ' LOG
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />SAP557108812
<br />8/1/2024
<br />8/112025
<br />COMBINEDSINGLELIMIT
<br />Ea accident
<br />$2,000,00C
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />OWNED SCHEDULE{]
<br />AUTOS ONLY AUTOS
<br />GOD ILY INJURY Per accident
<br />( 1
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />S
<br />$
<br />C
<br />UMBRELLA LIAB
<br />X OCCUR
<br />TLJE347403604
<br />8/1/2024
<br />8/1/2025
<br />EACH OCCURRENCE
<br />S 10,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />S 10,000,000
<br />DED I X I RETENTION
<br />Following -Form
<br />$
<br />g
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y 1 N
<br />ANYPROPRIETORIPARTNEPJFXECUTIVE
<br />OFFICERIMEMBEREXCLUDED7 El
<br />NIA
<br />VVC593205711
<br />8/1/2024
<br />8/1/2025
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1.000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L, DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Contractor's Equipment
<br />CPP567109412
<br />811/2024
<br />8/112025
<br />$5,000,000 Limit
<br />Special Forrn
<br />Tu Tran 4 .'',,,^�
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Nguye
<br />Certificate Holder is Additional insured if Required by Written Contract Excluding Workers Compensation 2025.a3.as
<br />#362821 Job #23-67021 RE: Grand Avenue Roadway Rehabilitation from McFadden Avenue to First Street 1 n a:55�<-00n0
<br />City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers.
<br />APPROVED
<br />By Tu Tran Nguyen at 10:54 am, Mar 05, 2025
<br />. ten I IVI%IM I c nvL.vcrt I,ANGtLLA I IUN
<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 PROVISIONS.
<br />Attention: Public Works Agency — CIP Engineering
<br />20 Civic Center Plaza, M-22 AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701 f
<br />Ur 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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