COI - Assured Aggregates Co., Inc - Expires 2022-10-01v
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P52(a12WX)1
A� V CERTIFICATE OF LIABILITY INSURANCE
09 9/20221
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(les) 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 endorsements .
PRODUCER LIC #OM77949 1-831-724-3841
McSherry & Hudson, LLC Insurance Services
CONTACT
PHONE FAx
A/C No):
35 Penny Lane, Suite 6
P. 0. Box 2690
Watsonville, CA 95076
E-MAIL
DDRESS:
INSURERS AFFORDING COVERAGE
NAIL 0
INSURER A: ZURICH AMERICAN INS CO
16535
INSURED
INSURER B :
ASSURED AGGREGATES CO., INC
INSURER C
INSURERD:
520-A CRAZY HORSE CANYON ROAD
INSURERE:
SALINAS, CA 93907
INSURER F :
CnVFROGFS CERTIFICATE NIIMRFR- 63389950 RFVISI[]M MIIMRFR-
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
LTR
TYPE OF INSURANCE
BR
POLICY NUMBER
POLICY EFF
MM D
POLICY EXP
D
LIMITS
A
O£NERALLIABILITY
X
X
GLO9674283-11
10/01/2]
10/01/22
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
DAMAGET NTED
PREMISES Ea oxurrence
$ 1, 000 , 000
MED EXP (Any one person
$ 10, 000
PERSONAL & ADV INJURY
$1,000,000
X Contractual Liability
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2, 000, 000
POLICY PRO LOC
$
A
AUTOMOBILELiAsiLnY
X
X
BAP9674285-11
10/01/21
10/01/22
CEOMBINN DSINGLELIMIT e accident)
1,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per acadent)
$
PROPERTY DAMAGE
Per ideni
_
X HIRED AUTOS X NON -OWNED
AUTOS
$
X Contractua
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYTORY
ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
OFFICERIMEMBER EXCLUDED? IN
(Mandatory In NH)
N I A
X
WC 9674284-13
10/01/2
10/01/22
X WCSTATU- JOTH.
LIMITS
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
Una , describe under
DCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1, 000, 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Ia required)
AS RESPECTS EXTRA LEGAL LOADS - ANNUAL TRANSPORTATION PERMIT
CITY OF GILROY, ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS, EMPLOYEES, AGENTS AND
VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED PER ATTACKED ENDORSEMENTS.
GL PER ISO FORDS C00001 04/13; AL PER ISO FORM CA0001 10/13
CERTIFICATE HOLDER CANCELLATION
CITY OF GILROY, ITS OFFICERS, ELECTED OR APPOINTED
OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS
RISK MANAGER
7351 ROSANNA STREET
GILROY, CA 95020
ACORD 25 (2010/05)
yrivera
63388950
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
01988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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ENV 2235 2 OF 10 B
P32(AX12K002
Additional Insured — Automatic — Owners, Lessees Or
Contractors
E. LL
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy No. GLO9674283-11 Effective Date:10/01/2021
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization whom you
are required to add as an additional insured under a written contract or written agreement executed by you, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" and subject to the
following:
1. If such written contract or written agreement specifically requires that you provide that the person or organization
be named as an additional insured under one or both of the following endorsements:
a. The Insurance Services Office (ISO) ISO CG 20 10 (10/01 edition); or
b. The ISO CG 20 37 (10/01 edition),
such person or organization is then an additional insured with respect to such endorsement(s), but only to the
extent that "bodily injury", "property damage" or "personal and advertising injury" arises out of:
(1) Your ongoing operations, with respect to Paragraph 1.a. above; or
(2) "Your work", with respect to Paragraph 1.b. above,
which is the subject of the written contract or written agreement.
However, solely with respect to this Paragraph 1., insurance afforded to such additional insured:
(a) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense
occurs during the policy period and subsequent to your execution of the written contract or written
agreement; and
(b) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the
"products -completed operations hazard" unless the written contract or written agreement specifically
requires that you provide such coverage to such additional insured.
2. If such written contract or written agreement specifically requires that you provide that the person or organization
be named as an additional insured under one or both of the following endorsements:
a. The Insurance Services Office (ISO) ISO CG 2010 (07/04 edition); or
b. The ISO CG 20 37 (07/04 edition),
such person or organization is then an additional insured with respect to such endorsement(s), but only to the
extent that "bodily injury", "property damage" or "personal and advertising injury" is caused, in whole or in part, by:
(1) Your acts or omissions; or
(2) The acts or omissions of those acting on your behalf,
U-GL-2162-A CW (02119)
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in the performance of:
(a) Your ongoing operations, with respect to Paragraph 2.a. above; or
(b) "Your work" and included in the "products -completed operations hazard", with respect to Paragraph
2.b. above,
which is the subject of the written contract or written agreement.
However, solely with respect to this Paragraph 2., insurance afforded to such additional insured:
(1) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense
occurs during the policy period and subsequent to your execution of the written contract or written
agreement; and
(III) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within
the "products -completed operations hazard" unless the written contract or written agreement
specifically requires that you provide such coverage to such additional insured.
3. If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that
you provide that the person or organization be named as an additional insured:
a. Under the ISO CG 20 10 (04/13 edition, any subsequent edition or if no edition date is specified); or
b. With respect to ongoing operations (if no form is specified),
such person or organization is then an additional insured only to the extent that "bodily injury", "property damage"
or "personal and advertising injury" is caused, in whole or in part by:
(1) Your acts or omissions; or
(2) The acts or omissions of those acting on your behalf,
in the performance of your ongoing operations, which is the subject of the written contract or written
agreement.
However, solely with respect to this Paragraph 3., insurance afforded to such additional insured:
(a) Only applies to the extent permitted by law;
(b) Will not be broader than that which you are required by the written contract or written agreement to
provide for such additional insured; and
(c) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense
occurs during the policy period and subsequent to your execution of the written contract or written
agreement.
4. If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that
you provide that the person or organization be named as an additional insured:
a. Under the ISO CG 20 37 (04/13 edition, any subsequent edition or if no edition date is specified); or
b. With respect to the "products -completed operations hazard" (if no form is specified),
such person or organization is then an additional insured only to the extent that "bodily injury" or "property
damage" is caused, in whole or in part by "your work" and included in the "products -completed operations
hazard", which is the subject of the written contract or written agreement.
However, solely with respect to this Paragraph 4., insurance afforded to such additional insured:
(1) Only applies to the extent permitted by law;
(2) Will not be broader than that which you are required by the written contract or written agreement to
provide for such additional insured;
(3) Only applies if the "bodily injury" or "property damage" occurs during the policy period and subsequent to
your execution of the written contract or written agreement; and
Includes copyrighted material of Insurance Services office, Inc., with its permission.
U-GL-2162-A CW (02/19)
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P52G[N12YAX12
4 Does not apply to "bodil injury" or "roe damage" caused b "your work" and included within the
() PPY Y�jrY" "property 9 Y Y
"products -completed operations hazard" unless the written contract or written agreement specifically
requires that you provide such coverage to such additional insured.
B. Solely with respect to the insurance afforded to any additional insured referenced in Section A. of this endorsement,
the following additional exclusion applies:
This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of
the rendering of, or failure to render, any professional architectural, engineering or surveying services including:
1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field
orders, change orders or drawings and specifications; or
2. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the
"bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the
rendering of or the failure to render any professional architectural, engineering or surveying services.
C. Solely with respect to the coverage provided by this endorsement, the following is added to Paragraph 2. Duties In
The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Commercial General Liability Conditions:
The additional insured must see to it that:
(1) We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
(2) We receive written notice of a claim or "suit" as soon as practicable; and
(3) A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued
by another insurer under which the additional insured may be an insured in any capacity. This provision does
not apply to insurance on which the additional insured is a Named Insured if the written contract or written
agreement requires that this coverage be primary and non-contributory.
D. Solely with respect to the coverage provided by this endorsement:
1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability
Conditions:
Primary and Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional
insured provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by written contract or written agreement that this insurance be primary and not seek
contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition under Section IV —
Commercial General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an
additional insured, in which the additional insured on our policy is also covered as an additional insured on
another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not
apply to any policy in which the additional insured is a Named Insured on such other policy and where our
policy is required by a written contract or written agreement to provide coverage to the additional insured on a
primary and non-contributory basis.
E. This endorsement does not apply to an additional insured which has been added to this Coverage Part by an
endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies
specifically to that identified additional insured.
U-GL-2162-A CW (02119)
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F. Solely with respect to the insurance afforded to an additional insured under Paragraph A.3. or Paragraph A.4. of this
endorsement, the following is added to Section III — Limits Of Insurance:
Additional Insured — Automatic — Owners, Lessees Or Contractors Limit
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Section A. of this endorsement; or
2. Available under the applicable Limits of Insurance shown in the Declarations,
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
All other terms, conditions, provisions and exclusions of this policy remain the same.
U-GL-2162-A CW (02/19)
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P526(X12*HJ2
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POLICY NUMBER: GLO9674283-11
COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
ANY PERSON OR ORGANIZATION THAT REQUIRES YOU TO WAIVE YOUR RIGHTS OF
RECOVERY, IN A WRITTEN CONTRACT OR AGREEMENT WITH THE NAMED INSURED
THAT IS EXECUTED PRIOR TO THE ACCIDENT OR LOSS.
Information required to complete this Schedule if not shown above will be shown in the Declarations.
The following is added to Paragraph & Transfer Of
Rights Of Recovery Against Others To Us of Section
IV — Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing operations or
"your work" done under a contract with that person
or organization and included in the "products -
completed operations hazard". This waiver applies
only to the person or organization shown in the
Schedule above.
CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 0
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Blanket Notification to Others of Cancellation
or Mon -Renewal
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy No. GL09674283-11 Effective Date: 10/01/2021
This endorsement applies to insurance provided under the:
Commercial General Liability Coverage Part
A. If we cancel or non -renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver
notification that such Coverage Part has been cancelled or non -renewed to each person or organization shown in a
list provided to us by the first Named Insured if you are required by written contact or written agreement to provide
such notification. Such list:
1. Must be provided to us prior to cancellation or non -renewal;
2. Must contain the names and addresses of only the persons or organizations requiring notification that such
Coverage Part has been cancelled or non -renewed; and
3. Must be in an electronic format that is acceptable to us.
B. Our notification as described in Paragraph A. of this endorsement will be based on the most recent list in our records
as of the date the notice of cancellation or non -renewal is mailed or delivered to the first Named Insured. We will mail
or deliver such notification to each person or organization shown in the list:
1. Within 10 days of the effective date of the notice of cancellation, if we cancel for non-payment of premium; or
2. At least 30 days prior to the effective date of:
a. Cancellation, if cancelled for any reason other than nonpayment of premium; or
b. Non -renewal, but not including conditional notice of renewal,
unless a greater number of days is shown in the Schedule of this endorsement for the mailing or delivering of such
notification with respect to Paragraph 8.1. or Paragraph B.2. above.
C. Our mailing or delivery of notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy
only. Our failure to provide such mailing or delivery will not:
1. Extend the Coverage Part cancellation or non -renewal date;
2. Negate the cancellation or non -renewal; or
3. Provide any additional insurance that would not have been provided in the absence of this endorsement.
U-GL-1521-13 CW (01/19)
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D. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list provided
to us as described in Paragraphs A. and B. of this endorsement.
SCHEDULE
The total number of days for mailing or delivering with respect to Paragraph B.1. of
15*
this endorsement is amended to indicate the following number of days:
The total number of days for mailing or delivering with respect to Paragraph B.2. of
30**
this endorsement is amended to indicate the following number of days:
* If a number is not shown here, 10 days continues to apply.
** If a number is not shown here, 30 days continues to apply.
All other terms and conditions of this policy remain unchanged.
U-GL-1521-13 CW (01119)
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Coverage Extension Endorsement
Policy No.
Eff. Date of Pal.
Exp. Date of Pal.
Eff. Date of End.
Producer No.
I Add'I. Prem
Retum Prem.
BAP9674285-11
110101/2021
10/01/2022
10101/2021
Mherry&Hudsani
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Carrier Coverage Form
A. Amended Who Is An Insured
1. The following is added to the Who Is An Insured Provision in Section 11— Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts
performed within the scope of employment by you. Any "employee" of yours is also an "insured" while
operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your
permission, while performing duties related to the conduct of your business.
b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or
borrow to transport your clients or other persons in activities necessary to your business.
c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement.
d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract
or written agreement with you executed prior to any "accident", including those person(s) or organization(s)
directing your work pursuant to such written contract or written agreement with you, provided the "accident"
arises out of operations governed by such contract or agreement and only up to the limits required in the
written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other
Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you
executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained
by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond
the terms and conditions of the Coverage Form.
B. Amendment — Supplementary Payments
Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II — Covered Autos Liability
Coverage are replaced by the following:
(2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an
"accident" we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a
day because of time off from work.
U-CA-424-F CW (04/14)
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C.
Fellow Employee Coverage
The Fellow Employee Exclusion contained in Section II — Covered Autos Liability Coverage does not apply.
D.
Driver Safety Program Liability and Physical Damage Coverage
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1. The following is added to the Racing Exclusion in Section II — Covered Autos Liability Coverage:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
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limited to, auto or truck rodeos and other auto or truck agility demonstrations.
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2. The following is added to Paragraph 2. in the Exclusions of Section III — Physical Damage Coverage of the
Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage
Coverage of the Motor Carrier Coverage Form:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
limited to, auto or truck rodeos and other auto or truck agility demonstrations.
E.
Lease or Loan Gap Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Lease Or Loan Gap Coverage
In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered
"auto", less:
a. Any amount paid under the Physical Damage Coverage Section of the Coverage Form; and
b. Any:
(1) Overdue lease or loan payments at the time of the 'loss";
(2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;
(3) Security deposits not returned by the lessor;
(4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the
loan or lease; and
(5) Carry-over balances from previous leases or loans.
F.
Towing and Labor
Paragraph A.2. of the Physical Damage Coverage Section is replaced by the following:
We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is
disabled. However, the labor must be performed at the place of disablement.
G.
Extended Glass Coverage
The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section:
If glass must be replaced, the deductible shown in the Declarations will apply. However, if glass can be repaired and
is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass
repaired rather than replaced.
H.
Hired Auto Physical Damage — Increased Loss of Use Expenses
The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Section is replaced by the
following:
Loss Of Use Expenses
For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for
loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We
will pay for loss of use expenses if caused by:
U-CA-424-F CW (04/14)
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P52(AX)28(X)2
(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered
"auto";
(2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided
for any covered "auto"; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto".
However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of $3000.
I. Personal Effects Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Personal Effects Coverage
a. We will pay up to $750 for "loss" to personal effects which are:
(1) Personal property owned by an "insured"; and
(2) In or on a covered "auto".
b. Subject to Paragraph a. above, the amount to be paid for "loss" to personal effects will be based on the lesser of:
(1) The reasonable cost to replace; or
(2) The actual cash value.
c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered
"auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of
the following:
(1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other
documents of value.
(2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches,
precious or semi-precious stones.
(3) Paintings, statuary and other works of art.
(4) Contraband or property in the course of illegal transportation or trade.
(5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment.
Any coverage provided by this Provision is excess over any other insurance coverage available for the same "loss".
J. Tapes, Records and Discs Coverage
1. The Exclusion in Paragraph 13.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage
Form and the ' Exclusion in Paragraph 13.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier
Coverage Form does not apply.
2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the
Physical Damage Coverage Section:
We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic
equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices:
(a) Are the property of an "insured"; and
(b) Are in a covered "auto" at the time of "loss".
The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical
Damage Coverage Deductible Provision does not apply to such "loss".
u-CA-424-F cw (04/14)
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K. Airbag Coverage
U.-
The Exclusion in Paragraph B.3.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form
U.
and the Exclusion in Paragraph 113.4.a. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage
o
Form does not apply to the accidental discharge of an airbag.
00
L. Two or More Deductibles
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The following is added to the Deductible Provision of the Physical Damage Coverage Section:
M
N
If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you
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by us, the following applies for each covered "auto" on a per vehicle basis:
1. If the deductible on this policy or Coverage Form is the smaller (or smallest) deductible, it will be waived; or
2. If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by
the amount of the smaller (or smallest) deductible.
M. Physical Damage — Comprehensive Coverage — Deductible
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
Regardless of the number of covered "autos" damaged or stolen, the maximum deductible that will be applied to
Comprehensive Coverage for all "loss" from any one cause is $5,000 or the deductible shown in the Declarations,
whichever is greater.
N. Temporary Substitute Autos — Physical Damage
1. The following is added to Section I — Covered Autos:
Temporary Substitute Autos — Physical Damage
If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following
types of vehicles are also covered "autos" for Physical Damage Coverage:
Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered
"auto" you do own but is out of service because of its:
1. Breakdown;
2. Repair;
3. Servicing;
4. "Loss"; or
S. Destruction.
2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section:
Temporary Substitute Autos — Physical Damage
We will pay the owner for "loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or
omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other
party.
The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it
replaces.
0. Amended Duties In The Event Of Accident, Claim, Suit Or Loss
Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following:
a. In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice
of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or
"loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited
liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any
U-CA-424-F CW (04/14)
Page 4 of 6
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate
the insurance afforded by this policy. o
Include, as soon as practicable: o
00
(1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written
notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit"; in
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(2) The "insured's" name and address; and N
(3) To the extent possible, the names and addresses of any injured persons and witnesses. LLI
If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your
failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon
as practicable after the fact of the delay becomes known to you.
P. Waiver of Transfer Of Rights Of Recovery Against Others To Us
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or
"loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only
applies to the person or organization designated in the contract.
Q. Employee Hired Autos — Physical Damage
Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other
Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced
by the following:
For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own:
(1) Any covered "auto" you lease, hire, rent or borrow; and
(2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or
elected or appointed official with your permission while being operated within the course and scope of that
"employee's" employment by you or that elected or appointed official's duties as respect their obligations to you.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".
R. Unintentional Failure to Disclose Hazards
The following is added to the Concealment, Misrepresentation Or Fraud Condition:
However, we will not deny coverage under this Coverage Form if you unintentionally:
(1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or
(2) Make an error, omission, improper description of "autos" or other misstatement of information.
You must notify us as soon as possible after the discovery of any hazards or any other information that was not
provided to us prior to the acceptance of this policy.
S. Hired Auto — World Wide Coverage
Paragraph 7a.(5) of the Policy Period, Coverage Territory Condition is replaced by the following:
(5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less,
T. Bodily Injury Redefined
The definition of "bodily injury" in the Definitions Section is replaced by the following:
"Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish,
resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease.
U-CA-424-F CW (04/14)
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Includes copyrighted material of Insurance Services Office, Inc., with its permission.
P52<aM)28(X)2
U. Expected Or Intended Injury - MR
The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II — Covered Auto Liability
Coverage is replaced by the following: 0
Expected Or Intended Injury
"Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". This exclusion does N
not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or
property. z
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V. Physical Damage — Additional Temporary Transportation Expense Coverage
Paragraph A.4.a. of Section III — Physical Damage Coverage is replaced by the following:
4. Coverage Extensions
a. Transportation Expenses
We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you
because of the total theft of a covered "auto" of the private passenger type. We will pay only for those
covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will
pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and
ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its
"loss".
W. Replacement of a Private Passenger Auto with a Hybrid or Alternative Fuel Source Auto
The following is added to Paragraph A. Coverage of the Physical Damage Coverage Section:
In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or
"auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost
of the replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a
maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative
fuel source within 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease
agreement.
To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of
propulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas,
either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must be
powered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled by
biofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source.
X. Return of Stolen Automobile
The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section:
If a covered "auto" is stolen and recovered, we will pay the cost of transport to return the "auto" to you. We will pay
only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage.
All other terms, conditions, provisions and exclusions of this policy remain the same.
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Includes copyrighted material of Insurance Services Office, Inc., with its permission.
P 12(A NI2}gNl2
Blanket Notification to Others of Cancellation
or Non -Renewal
r
Cis-•
ZURICH
Policy No.
Eff. Date of Pol.
Exp. Date of Pol.
Eff. Date of End.
Producer No.
AWL Prem
Return Prem.
BAP9674285-11
10/01 /2021
10/01 /2022
10101/2021
71235000
1 IN CL
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial Automobile Coverage Part
A. If we cancel or non -renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver
notification that such Coverage Part has been cancelled or non -renewed to each person or organization shown in a list
provided to us by the first Named Insured if you are required by written contact or written agreement to provide such
notification. However, such notification will not be mailed or delivered if a conditional notice of renewal has been sent
to the first Named Insured. Such list:
1. Must be provided to us prior to cancellation or non -renewal;
2. Must contain the names and addresses of only the persons or organizations requiring notification that such
Coverage Part has been cancelled or non -renewed; and
3. Must be in an electronic format that is acceptable to us.
B. Our notification as described in Paragraph A. of this endorsement will be based on the most recent list in our records
as of the date the notice of cancellation or non -renewal is mailed or delivered to the first Named Insured. We will mail
or deliver such notification to each person or organization shown in the list:
1. Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of premium; or
2. At least 30 days prior to the effective date of:
a. Cancellation, if cancelled for any reason other than nonpayment of premium; or
b. Non -renewal, but not including conditional notice of renewal.
C. Our mailing or delivery of notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy
only. Our failure to provide such mailing or delivery will not:
1. Extend the Coverage Part cancellation or non -renewal date;
2. Negate the cancellation or non -renewal; or
3. Provide any additional insurance that would not have been provided in the absence of this endorsement.
D. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list provided
to us as described in Paragraphs A. and B. of this endorsement.
All other terms and conditions of this policy remain unchanged.
U-CA-832-A CW (01/13)
Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
P526(X)21WM12
a .
N
.
POLICY NO. WC9674284-13
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-
CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in
the work described in the Schedule.
The additional premium for this endorsement shall be 0.00 % of the California workers' compensation pre-
mium otherwise due on such remuneration.
Person or Organization
ALL PERSONS AND/OR
ORGANIZATION THAT
ARE REQUIRED BY
WRITTEN CONTRACT OR
AGREEMENT WITH THE
INSURED, EXECUTED
PRIOR TO THE
ACCIDENT OR LOSS,
THAT WAIVER OF
SUBROGATION BE
PROVIDED UNDER THIS
POLICY FOR WORK
PERFORMED BY YOU FOR
THAT PERSON AND/OR
ORGANIZATION.
We 252 (4.84)
WC 04 03 06 (Ed. 4-84)
Schedule
Job Description
ALL CA OPERATIONS
Page 1 of 1
P.5264N) 1N12
3
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 43
M_
0
BLANKET NOTIFICATION TO OTHERS OF CANCELLATION OR NONRENEWAL ENDORSEMENT o
This endorsement adds the following to Part Six of the policy.
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N
N
PART SIX z
CONDITIONS
Blanket Notification to Others of Cancellation or Nonrenewal
1. If we cancel or non -renew this policy by written notice to you, we will mail or deliver notification that such policy
has been cancelled or non -renewed to each person or organization shown in a list provided to us by you if you
are required by written contract or written agreement to provide such notification. However, such notification
will not be mailed or delivered if a conditional notice of renewal has been sent to you. Such list:
a. Must be provided to us prior to cancellation or non -renewal;
b. Must contain the names and addresses of only the persons or organizations requiring notification that
such policy has been cancelled or non -renewed; and
c. Must be in an electronic format that is acceptable to us.
2. Our notification as described in Paragraph 1. above will be based on the most recent list in our records as of
the date the notice of cancellation or non -renewal is mailed or delivered to you. We will mail or deliver such
notification to each person or organization shown in the list:
a. Within seven days of the effective date of the notice of cancellation, if we cancel for non-payment of
premium; or
b. At least 30 days prior to the effective date of:
(1) Cancellation, if cancelled for any reason other than nonpayment of premium; or
(2) Non -renewal, but not including conditional notice of renewal.
3. Our mailing or delivery of notification described in Paragraphs 1. and 2. above is intended as a courtesy only.
Our failure to provide such mailing or delivery will not:
a. Extend the policy cancellation or non -renewal date;
b. Negate the cancellation or non -renewal; or
c. Provide any additional insurance that would not have been provided in the absence of this endorsement.
4. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list
provided to us as described in Paragraphs 1. and 2. above.
All other terms and conditions of this policy remain unchanged.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is Issued subsequent to preparation of the policy.)
Endorsement Effective 10101/2021
Insured: Assured Aggregates Company,
Inc.
Insurance Company:
Zurich American Insurance Company
Policy No. WC9674284-13 Endorsement No.
Premium $
WC 99 06 43 Page 1 of 1
(Ed. 01-13) Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission.
0 2012 Copyright National Council on Compensation Insurance, Inc. All Rights Reserved.