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CMP02D USS CAL BLDRS INSURANCEOP ID: AD ACORQ" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 07/26/12 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(ies) 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 endorsement(s). PRODUCER 949- 553 -9800 The Wooditch Company Insurance 949 -553 -0670 Services, Inc. 1 Park Plaza, Suite 400 Irvine, CA 92614 Robert Welbourn NAMEACT PRONE FAX c N AIC No E -MAIL ADDRESS' PRODUCE USSCA -1 INSURERS AFFORDING COVERAGE NAIC # I%SURSO LESS Cal Builders, Inc. 8051 Main Street Stanton, CA 90680 INSURER A: Liberty Insurance Underwriters '19917 INSURER 8: Starr I ndem nity & Liability Co 38318 INSURER C INSURER D: EACH OCCURRENCE INSURER E: A 1144SURER F___ X COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- 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 ADDL SUBR POUCYI%UMBER POLICY EFF POLICY EXP MIDntYYYYi, LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X X AGS0028000 07/01/12 07/01113 PREMISES TO occurrence $ 50,00 MED EXP (Any one person) $ 5,00 PERSONAL & A.DV INJURY $ 1 ,000,00 X GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,00 POLICY X PRO LOG $ B AUTOMOBfLELIABfLfTY X ANY AUTO X X SISIPCA08237412 07/01112 07/01113 CONIBiNED ONGLE L WiT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS €'RL`P` =RTY L'A4JfAGE (Per accident) $ $ NON -OWNED AUTOS UMBRELLA LIAR )( OCCUR EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 A X EXCESS LIAB CLAIMS -MADE — EXCLA263419 -1 07/01/12 07/01/13 DEDUCTIBLE -- $ $ RETENTION S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SCRfTION OF OPERATIONS below NIA X 100 - 0}01030 07/01112 07/01/13 X TORY IM1T5 OER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E. L. DOERSE - POLICY LIMIT $ 1,000,00 B Pollution I I SISIEIL70111512 06/25112 07/01/13 Per Occ. 5,000,00 Liability Aggregate 5,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES Attach ACORD 101, Additlonal Remarks Schedule, If more space is required) *Except 10 Days Notice of Cancellation for Non- Payment of Premium. RE: USS Cal Builders Job #J240; City of Encinitas Project #CMP02D; Encinitas Community Park. City of Encinitas, its officers, elected officials, agents and employees are included as Additional Insureds as respects General and M=ahilaty nAr attached endorsements- * " ala CITYENC City of Encinitas Park & Beach Superintendent 505 South Vulcan Avenue Encinitas„ CA 92024 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 rJ 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD NoText NoText Policy- Nunnber_ AGS0028000 COMMERCIAL GENERAL LIABILTTY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons) Or Oraganization(s) Location And Description Of Completed Operations WHERE REQUIRED BY WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above, Ntill be shown in the Declarations. Section H — Who Is An Insured is amended to include as an additional instircd the persons) or organization(s) slto« n in the Schedule. but only with respect to liability for "bodily- h1jur "' or "properh- dam- age" caused. in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and. included in the "products - completed operations hazard ". CG 20 37 07 04 a ISO Properties, Inc., 2004 Page 1 of T Poliev Number: AGS0028000 Named. Insured: USS Cal Builders, Inc. CG 20 10 07 04 Effective Date: 07/01/12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE .READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS LESSEES OR CONTRACTORS- SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE INHERE REQUIRED BY WRITTEN CONTRACT. Name of Person or Organization: (lf no entry appears above, information required to complete, this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) sho�N n in the Schedule, but only with respect to liability for "bodily in}ur `, `property damage" or "personal and advertising injun" caused, in whole or in part, by- 1. Your acts or omissions; or 2. The acts or omission of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply This insurance does not apply to "bodily injury" or "property- damage" occurring after: 1. All ivork, including materials, parts or equipment furnished in CG 2010 07 04 ISO Properties, Inc. 2000 connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed, or 2. That portion of "your work" out of which the injure or damage arises has been put to it's intended. use by anv person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. POLICY NUMBER: AGS0028000 COMMERCIAL GENERAL LIABILITY CG 24 04 06 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: WHERE REQUIRED BY WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8, 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 13 POLICY NUMBER: SISIPCA08237412 COMMERCIAL AUTO CA 20 01 03 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below_ Named Insured: USS Cal Builders, Inc. Endorsement Effective Date: 7/112012 Countersignature Of Authorized Representative Name: Jim Vendetti Title: Signature: Date: 6129/2012 CA 20 01 03 06 O ISO Properties, Inc., 2005 Page 1 of 3 ❑ SCHEDULE Insurance Company: Starr Indemnity & Liability Company Policy Number: Effective Date: 7/1/2012 Expiration Date: 7/1/2013 Named Insured: USS Cal Builders, Inc. Address: 8051 Main Street, Stanton, CA 90680 Additional Insured (Lessor): As required by a written contract Address: Designation Or Description Of "Leased Autos ": As required by a written contract Coverages Limit Of Insurance Liability $ 1,000,000 Each "Accident" Actual Cash Value Or Cost Of Repair Whichever Is Less, Minus Comprehensive $ 2,000 Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of Repair Whichever Is Less, Minus Collision $ 2,000 Deductible For Each Covered "Leased Auto" Actual Cash Value Or Cost Of 'Repair `J hichever Is Less, Minus Specified Causes Of Loss $ Deductible For Each Covered "Leased Auto" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Coverage 1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow. 2. For a "leased auto" designated or described in the Schedule, Who Is An Insured is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. Page 2 of 3 U ISO Properties, Inc., 2005 CA 20 01 03 06 ❑ 3. The coverages provided under this endorsement apply to any "leased auto' described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto ", whichever occurs first. B. Loss Payable Clause 1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto ". 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor, we will obtain his or her rights against any other party. C. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premiums. E. Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. CA 20 01 03 06 O ISO Properties, Inc., 2005 Page 3 of 3 11 POLICY NUMBER: SISIPCA08237412 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: USS Cal Builders Endorsement Effective Date: 0710112012 to 07/01/2013 SCHEDULE Name(s) Of Person(s) Or Organization(s): Where required by a written contract. I information required to complete this Schedule, if not shown above, will be shown in the Declarations The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 © Insurance Services Office, Inc., 2009 Page 1 of 1 0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurance of loss. 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 07/01/2012 to 0701/2013 Policy No. 10ti OO1€i30 Endorsement No. Insured USS Cal Builders, Inc. Premium $27,068 Insurance Company: Starr Indemnity Countersigned by WC 00 03 13 (Ed. 4 -84) Copyright 1983 National Council on Compensation Insurance.