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ACORO® DATE(MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/29/2015 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 a certificate holder in lieu of such endorsement(s). m PRODUCER CCOONTACT 10 Aon Risk Services Northeast, Inc. pAX New York NY Office (AIC.No.Ext: (866).283-7122 A�No* 800 363-0105 199 Water Street E-MAIL p New York NY 10038-3551 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Indian Harbor Insurance Company 36940 community Asphalt Corp. INSURERa: Illinois National Insurance Co 23817 9675 N.W. 117th Avenue Suite 106 INSURER c: National Union Fire Ins Co of Pittsburgh 19445 Miami FL 33178 USA INSURER D: The Insurance co of the State of PA 19429 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570060732243 REVISION NUMBER: 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. Limits shown are as requested A011LTR TYPE POLICY LFF POLICY E.P INSR OF INSURANCE INS Hryp POLICY NUMBER MWDDrfYYY MMID LIMITS X COMMERCIAL GENERAL LIABILITY GL EACH OCCURRENCE SZ,000,000 CLAIMS-MADE X❑OCCUR nrs 5300,000 PREMISES a ocwrra MED EXP(Any one person) $10,000 PERSONAL a ADV INJURY $2,000,000 p GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $4,000,000 POLICY OJECT ❑LOC PRODUCTS-COMP/OP AGG 54,000,000 0 OTHER: o n B AUTOMOBILE LIABILITY CA 1803797 12/31/2015 12/31/2016 COMBINED SINGLE LIMIT 51,750,000 Ea accident X ANY AUTO BODILY INJURY(Per person) Z ALL OWNED SCHEDULED BODILY INJURY(Per accident)AUTOS M AUTOS NON-OWNED PROPERTY DAMAGE W HIRED AUTOS AUTOS Per accident 1= m C X UMBRELLA UAB X OCCUR BE011133166 12 31 2015 12 31 2016 EACH OCCURRENCE $1,000,000 t) EXCESS I_,. CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION 510,000 D WORKERS COMPENSATION AND wc04934Z268 1273-17260=1r/31/20165 X STATUTE oTH- EMPLOYERS'LIABILITY ANY PR OPRIETORIPARTNER I EXECUTIVE YIN E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,()00,000 B yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000-_ A Pollution cvg CEo7420S7001 F2/31/2015112/31/2016 Each Location 510,000,000 SIR applies per policy ter & condi I ions Aggregate $10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Evidence of Coverage s. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE - EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Community Asphalt AUTHORIZED REPRESENTATIVE 9675 Nw 117 Ave,suite 108 Miami FL 33178 USA �� /l�Q . �✓Gt1YLs. .t eM:'ted c/l��eJllCt 01988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD