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PROOF OF INSURANCE (2025).r PALP, INC. JCHR,I TIAN, A�""►RO` � CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/31/2024 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. ....... ----................................y. P IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the olic (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 '"". HUB International Insurance Services Inc. PHONE FAX 4695 MacArthur Court L ..• I —,•- ----- — L...IAIc Ne)........ ... Suite #600 A R '� Ext 9 9800 A/C N E dkI R"FSS Newport Beach, CA 92660 DAD INSURERS AFFORDING COVERAGE ,.... NAIC # .... ......... _._ ......... LNsI/RRz131TC0 Ggneral...(n Insurance Corporation 20095......... ....... INSURER B: INSURED Pal Inc. DBA Excel Paving Company; GAPEquipment, LLC.INSURER � ,Great American Insurance Company 16691 ----- .... _...,__ ..... .. 2230� Lemon Avenue 9 P YINSURER D ..... ...... . -- - Long Beach, CA 90806 INSUR R E ER F , COVERAGES ESCERTIFICATE 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A X C TYPE OF INSURANCE ------ I ,� 4-...... LIMITS ' COMMERCIAL GENERAL LIABILITY POLICY NUMBER POLICY EFF POLICY EXP INSR .... AODLISU IM(,pp�yXX�j (MM/DD/YYYXi- E000 ACH„OCCURRENCE CLAIMS -MADE .__ X occuR X XCPL3744561 6/1/2024 6/1/2025 DAMAGE TO RENTED $ 300,000 Mgpf((Any one persons ..... -_$ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEJN`L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ .. 2,000,000 _ �....., JEU gOO POLICY X ❑ LOC PRODUCTS CAMPIOP AGG $ 2,00 O0', OTHER, EB AGGREGATE 2 000 000 _..___... .....,m.� A 1,000, AUTOMOBILE LIABILITY COMBINED SINGLE. LIMIIT $ 000. , ANY AUTO X X CAP3744560 6/1/2024 6/1/2025 BODILYINJURY(Perp —n) I•„$v ,,,,,,,,,,,,,,,a ,_, OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED Np N O'u'�NF� ., X 7 P pand ntDAMAGE X... AUTOS ONLY AJfOS ON8 Y' I 1 UMBRELLA LIAB XXXXX X OCCUR EACH OCCURRENCE !c $ 000 B ._. — AGGREGATE __W .E ..,. -1 ...1 000 000 B CLAIMS -MADE TUE 3414395 04 6/1/2024 6/1/2025 11000,000, I X EXCESS LIA............... ......... DED RETENTION $ _ $ A WORKERS COMPENSATION X PER OTH AND EMPLOYERS' LIABILITY STfl:TITE ER' -- .-- m' I WC3744562 6/1/2024 6/1/2025 1000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE `Y I- X E L EACH ACCIDENT, $ ,,,, OFFICER/MEMBER EXCLUDED? J N / A „EA EMPLOYEE $ ' (Mandatory in NH) E L DISEASE- 1 000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E L. DISEASE- POLICY LIMIT $ l�T . . ........... ...- ..............._ ........ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Excel Job #5976. glaipwv/auaiwv/wcwvlagg City of El 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245 - •• ..... AUTHORIZED REPRESENTATIVE 4 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BITCO GENERAL INSURANCE CORPORATION BITCO NATIONAL INSURANCE COMPANY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE 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 WHEN REQUIRED BY EXECUTED WRITTEN CONTRACT. The premium charge for this endorsement is $ Named Insured PALP INC. DBA EXCEL PAVING COMPANY Policy Number WC 3744562 Endorsement No. 000 ._..._.............. ..... �. ...._............. _. Policy Period 06/01/24 to Endorsement Eff.. 06/01/25 ective Date: 06/01/24 _ _ _...... ............ _.... ... Producer's Name: HUB INTERNATIONAL INSURANCE SERVICES, INC. Producer Number: 0006686 AUTHORIZED REPRESENTATIVE DATE WC 99 03 15 (09/21) POLICY NUMBER: CLP 3744561 is deleted and replaced with the following: With respect to the conduct of any past or present joint venture or partnership not shown as a Named Insured in the Declarations and of which you are or were a partner or member, you are an insured, but only with respect to liability arising out of "your work" on behalf of any partnership or joint venture not shown as a Named Insured in the Declarations, provided no other similar liability insurance is available to you for "your work" in connection with your interest in such partnership or joint venture. B. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE — ONGOING OPERATIONS SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: Your acts or omissions; or The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the project(s) designated in the written contract. 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. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. C. AUTOMATIC WAIVER OF SUBROGATION Item 8. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted and replaced with the following: 8. Transfer of Rights of Recovery Against Others to Us and Automatic Waiver of Subrogation. a. If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair those rights. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. GL-3086 (10/19) -2- POLICY NUMBER: CLP 3744561 b. If required by a written contract executed prior to loss, we waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of "your work" for that person or organization. D. EXTENDED NOTICE OF CANCELLATION, NONRENEWAL Item A.2.1b. of the COMMON POLICY CONDITIONS, is deleted and replaced with the following: A.2.b. 60 days before the effective date of the cancellation if we cancel for any other reason. Item 9. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted and replaced with the following: 9. WHEN WE DO NOT RENEW If we choose to nonrenew this policy, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b. If we do not give notice of our intent to nonrenew as prescribed in a. above, it is agreed that you may extend the period of this policy for a maximum additional sixty (60) days from its scheduled expiration date. Where not otherwise prohibited by law, the existing terms, conditions and rates will remain in effect during that extension period. It is further agreed that so long as it is not otherwise prohibited by law, this one time sixty day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9. a. above. E. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. F. BROADENED MOBILE EQUIPMENT Item 12.b. of SECTION V - DEFINITIONS, is deleted and replaced with the following: 12.b. Vehicles maintained for use solely on or next to premises, sites or locations you own, rent or occupy. G. PERSONAL AND ADVERTISING INJURY - CONTRACTUAL COVERAGE Exclusion 2.e. of SECTION I, COVERAGE B is deleted. H. NONEMPLOYMENT DISCRIMINATION Unless "personal and advertising injury" is excluded from this policy: Item 14. of SECTION V - DEFINITIONS, is amended to include: "Personal and advertising injury" also means embarrassment or humiliation, mental or emotional distress, physical illness, physical impairment, loss of earning capacity or monetary loss, which is caused by "discrimination." SECTION V - DEFINITIONS, is amended to include:. "Discrimination" means the unlawful treatment of individuals based on race, color, ethnic origin, age, gender or religion. GL-3086 (10/19) -3- POLICY NUMBER: CLP 3744561 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, 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 project(s) designated in the written contract. 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: 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. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL-4667 (01 /11) Includes Copyrighted Material of Insurance Services Office With Its Permission ' • : E' COMMAL CB4ERAL CG t. 03 15 09 THIS EIMRSEIVIENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL UABIUTY COVERAGE PART Designated Constnaction Prgect(s): Where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. ♦ r� « ^:•• 1•.+...._ «•. « w.««.. 'CNN "`INr "' :��. «. �. •,w « �.: CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 EL For « a• becomes legally obligated to pay as darnages caused by "occur- medcEd expenses caused by accidents under Sec- tion I - Coverage q which cannot be attributed only to ongoing operations w - desigrated con- struction project• the Schedule above: 1. Any payrrients made under Coverage A for damages or under Camrage C for medical ex- penses sW1 reduce the amount available under OL the General Aggregate Unit or the ProdLds- corroeted Operations Aggregate Unit, W�ch- applicable; an• Desig- nated Construction ProjectAggregate Limit. E •- • • . • o• All 0, • • �r^ cations or timet es, t Art W11 still be deemed to•- the sameconstruction • •s The proAsions of • Of Insurance not othenMse modfiedby • • continue to apply as stipulated. Page 2 Of 2 01 nsurance Services Office, I nc., 2008 CG 25 03 05 09 POLJCY NUMBER CAP 3744560 A o "". 1 A 0 T1 ill Wri" A This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUST NESS AUTO COVERAGE FORM MOTOR CARRI ER COVERAGE FORM OMME ICiAL AUTO CA20481013 Wth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form This endorsement does not alter coverage provided in the Coverage Form 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 F�dorsernerrt EffeotiVe Date: 0 6/ 0 l/ 2 0 2 4 Name Of Person(s) Or Organization(s): Any person or organization for whom the named insured has agreed by written "insured contract" to designate as an additional insured subject to all the provisions and limitations of this policy. I_ Information required to corroete this Schedule, if not shown above, will be shown in the Declarations. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 . 0. 44 JJJS ENDORSEMENT CHANGES THE 'OPLEASE A CAREFULLY. AGNNST MUISi i US OF SUBROGAx" This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUS! NESS AUTO COVERAGE FORM MOTOR CARRI ER 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. Narried Insured: PALP INC. DBA EXCEL PAVING COMPANY iVe a 0 6 / 0 1 / 2 0 2 4 Narre(s) S) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. Information r uired to corriplete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of FAgIft Of RecoveryAgainst . Others To Us condition does not apply to the person(s) or organization(s) sh• «• only to the extent that, subrogation is, vwd• • to .••id or •sw- contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1