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�c CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY]
<br /> `—� 2119120213
<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 en or-sod.
<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
<br /> The Baldwin Group West, LLC PHONE Michael Tran Fax
<br /> 15901 Red Hill Ave, Ste 100 714 5fl5-7000 AlC No): 714 573-1770
<br /> Tustin CA 92780 It-MAIL SS: michael.tran w bib.com
<br /> INSURERS AFFORDING COVERAGE NAIC#
<br /> I icense#:OF69771 INSURER American Zurich Insurance Com 40142
<br /> INSURED ONYXPAV-01
<br /> Onyx Paving Company, Inc. INSURER a:Evanston Insurance Company 35378
<br /> 22707 La Palma Ave. INSURER C:Great American Insurance Coma 16691
<br /> Yorba Linda CA 92887 INSURERD:Scottsdale Insurance Company 41297
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1735525107 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 1S SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> INSR ADDL SUBR - POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMIDDIYYYY LIMITS
<br /> ❑ X COMMERCIAL GENERAL LIABILITY BC52DO3096 10A12025 10/1/2026 EACH OCCURRENCE $1,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES ER oncurrencel $100,000
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $1,000.000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
<br /> POLICY JEC F1 LOC
<br /> PRODUCTS-GOMPIOPAGG $2,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY BAP106300607 1011/2025 10/1/2026 COMBINED SINGLE LIMIT $1,000,000
<br /> Ea accident
<br /> X ANY AUTO BODILY INJURY(Per person) $
<br /> OWNED SCHEDULED SODILV INJURY Per accident) $
<br /> AUTOS ONLY AUTOS ( 1
<br /> X H{RED X NON-OWNED PROPERTYDAMAGE
<br /> AUTOS ONLY AUTOS ONLY Per accident $
<br /> C UMBRELLALIAB X OCCUR TUE49U440203 10/1/2025 1011/2026 EACH OCCURRENCE $6,000,000
<br /> X EXCESS LIAR CLAIMS-MADE
<br /> AGOREGATE $6,000,000
<br /> DIED RETENTION$ $
<br /> A WORKERS COMPENSATION W0106300507 10/1/2025 1011/2026 X SPER TATUTE OTH AND EMPLOYERS'LIABILITY Y 1 NER
<br /> ANYPROPRIETORIPARTNERIEXECUTIVE El NIA
<br /> E.L.EACH ACCIDENT $1,000,000
<br /> OFFICEWMEMBER EXCLU DED? -
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
<br /> B Contractors Pollut€on Liability MKLV5ENV105319 10/112025 1011/2026 Aggregate $10,000,000
<br /> Occurence $5,000,000
<br /> Deductible $10,000
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
<br /> —Excess Policy#TUE490440203 is Excess overthe General Liability,Auto Liability,and Workers Compensation`.,
<br /> Certificate holder(s)is/are named as additional insured per the attached endorsements as required by written contract subject to the terms&conditions of the
<br /> policy:
<br /> GL Additional Insured Form#CG 20 10 12 19 and CG 20 37 12 19
<br /> GL Additional Insured State-Permits Form#CG 20 12 12 19
<br /> GL Primary and Non-Contributory Form#CG 20 01 12 19
<br /> See Attached... APPROVED
<br /> CERTIFICATE HOLDER CANCELLATION SyTu Tran Nguyen at 12:56pm.Mar 11,2026
<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 /> 20 Civic Center Plaza
<br /> Santa Ana CA 92707 AUTHORIZED REPRESENTATIVE
<br /> 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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