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PROOF OF INSURANCE (2020) CLOSEDPALP, INC. JEA ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1129/2020 .............. ....... 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 have ADDITIONAL INSURED provisions or 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 %NTACT a/c"N . ExSI.;...949)....................9800 �.�nic...N.l 1949)..................._............ 553 553-0670 SS: �. ...... The Park Plaza, CompanyInsurance Services, Inc. INsuRER(siAPPORDI Nuc ............._ 1 Park Plaza, Shite 400 Irvine, CA 92614 NG COVERAGE INSURER .,A..,..Starr Indemnity & Liability Co ............ _,,,,„,,,I�38318 INSURED .-_ ................................................ .......... INSURE.R..E..S.......................... �................................ Palp, Inc. DBA Excel Paving Company; GAP Equipment, LLC INSURER C .. 2230 Lemon Avenue INSURER D: uG Long Beach, CA 90806 INSURER E ..INSURER. F............: COVERAGES CERTIFICATE NUMBER: _ 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 3OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. LIMITS .................... �A ..L..X.......COMMERCIAOF INSURANCE ...... POLICY NUMBE R ................. ..__.Y..-. _......... ...ITS_. TYPE.... ADDL SUBR POLICY EFF POLICY EXP J2.. INSD wV0 R MDDIVVYYI 1'MMfDDf'9fY'YYI L LIABILITY 1,000,000 CLAIMS -MADE l.. X.. X X Q.';zs'L�2. ndJd” 24... ................. GENERA OCCUR 1000025506191 611/2019 61112020 DAMAGC TO RENTED 100,000 GEmN'L AGGREGATE LIMIT APPLIES PER: POLICY X JET F_� LOC OTHERa m ....................._.. A AUTOMOBILE LIABILITY X ANY AUTO X OWNED 11 AUTOS ONLY �,AUTOSULED X HIRED X I NON -OWNED AUTOS ONLY7 I AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE _ ( RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE F ' MaD? FICER/MEMBER EXCLUDEN / A ndatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below w, ,MED EXP (Any one person) $ 5'000 .. 1.'. 00 00,000 000 PERSONAL 8 ADV INJURY $ , 00 __ $2,000 . ,0 ..,._ m,GE,N,E;,RAIAGGREGATE .. 2,0,COMP/OP 00,0„0000MBINED PRODUCTS - AGG $ „ SINGLE LIMIT 1,000,000 $................ X 1000198549191 6/112019 6/1/2020 BODILY INJURY (Pe p_wson),,,,,,,,,,_,,,,,Y,,,,,,,,,,,,,,,,,,,,,,,, INJURY (Per accident)., „Y,.......... .............. PORDILY P.? raccidpnIDAMAGE $.......................................,,,_ .......-� ............... $ _.EACH OCCURRENCE $ $ E orH- ...X 5T.AT.U1.9 F, R. X' 1000002214 6/112019 611/2020 .EL EAUH ,g 0 0 1,000,000 1,000,000 ESL._DISEAS„g,: EA„E,M,P,LOYEE r...... E... $ ....$ ..E 1'000'000 E.L. DISEASE -POLICY LIMIT $ ................. _. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required) RE: Excel Job 95727; City of El Segundo Job #PW 19-09; Walnut Avenue Drainage and Street Improvements. glaipwv/auaiwv/wcwv City of EI Segundo, its officers, officials, employees, agents, and volunteers are included as Additional Insureds as respects General Liability and Auto Liability per attached endorsements. This insurance shall apply as Primary and Non -Contributory per attached endorsement. Waiver of Subrogation for General Liability, Auto Liability and Workers' Compensation: See Attached Endorsements. CERTIFICATEHOLDER City of EI Segundo City Clerk 350 Main Street EI Segundo, CA 90245 ACORD 25 (2016103) 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PALP, INC. JEANA ........._.. .............._ ...................._................................ LOC #: 1 ........... — .... ._ CCOROe ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Palp, Inc. DBA Excel Paving Company; GAP Equipment, LLC 2230 Lemon Avenue POLICY NUMBER Long Beach, CA 90806 SEE PAGE 1 C A RIER N A I C CODE SE EPAG E 1 SEE P 1 EFFECTIVE...... DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:.?wP!C RD 2525 FORM TITLE: CeFgflpate of Liability Ins ur9nce,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Cancellation: *Except 10 days notice of Cancellation for non-payment of premium. *Should this policy be cancelled before the expiration date, The Wooditch Company will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.* ACORD 101 (2008/01) C 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD *Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: 1000198549191 Effective Date: 06/01/2019 Named Insured: Palp, Inc. DBA Excel Paving Company; GAP Equipment, LLC ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This policy is amended as follows: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON OR ORGANIZATIONS LIABILITY ARISING OUT OF THE USE OF A COVERED "AUTO" SECTION II — LIABILITY COVERAGE A. Coverage, 1. Who is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. SICA 1016 (02/12) Page 1 of 2 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 Signed for STARR INDEMNITY & LIABILITY COMPANY �P,V6 ; " /' Charles IH. Dangelo,19President Nehemiah E. Ginsburg, General" .ounsel SICA 1016 (02/12) Page 2 of 2 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. POLICY NUMBER: 1000198549191 COMMERCIAL AUTO CA 04 44 10 13 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: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER 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: Palp, Inc. DBA Excel Paving Company; GAP Equipment, LLC Endorsement Effective Date: 6/1/2019 SCHEDULE Name(s) Of Person(s) Or Organization(s): 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 occurrence of loss. -information required to complete this Schedule, if not shown above, will be shown in the Dectarations. 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 4410 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: 1000025506191 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Location And Description Of Completed Organization(s): Operations Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; 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. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 1000025506191 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 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 Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations li Where Required By Written Contract Where Required By Written Contract V Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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 for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 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 work, including materials, parts or equipment furnished in 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 injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 *Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 Primary and Non -Contributory Condition Policy Number: 1000025506191 Effective Date: 06/01/19 at 12:01 A.M. Named Insured: Palp, Inc. DBA Excel Paving Company This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SECTION IV — CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following is added to paragraph 4.a. of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured is a Named Insured. All other terms and conditions of this Policy remain unchanged. Signed for STARR INDEMNITY & LIABILITY COMPANY Charles H. Diaf°igelo, President Nehemiah E. Ginsburg, GeneraCounsel OG 107 (04111) Page 1 of 1 Copyright© C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with Its permission. POLICY NUMBER: 1000025506191 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 to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. 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 © Insurance Services Office, Inc., 2008 Page 1 of 1 Policy No: 1000002214 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) 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 2 .0 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Where required by contract 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 occurrence 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: 06/01/19 Policy No.: 1000002214 Endorsement No.: N/A Insured: Palp, Inc. DBA Excel Paving Company Premium: Insurance Company: Starr Indemnity & Liability Company Countersigned by: WC 04 03 06 (Ed. 04-84) Page 1 of 1