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PROOF OF INSURANCE (2019) CLOSED PALP,INC. C&?,,a"4�LME R,
.ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
05/25/2018
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 CONTACTNAM,E:,,
The Wooditch Company Insurance Services,Inc. ) ( )
PHO E Ext: 949 553-9800 FAx
1 Park Plaza Suite 400 rr�D4SS;
Irvine,CA 92614 AIc,No): 949 553-0670
I,N,SURER(S),AFFORDING COVERAGE
INSURER A:Starr Indemnity&Liability Co 38318
INSURED INSURER B:
Palp,Inc.DBA Excel Paving Company;GAP Equipment,LLC INSURERC:
2230 Lemon Avenue INSURER D:
Long Beach,CA 90806
INSURER E
INSURER F:
......................................................
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
......I'll _................................_.
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,
/NSR LTR ITITITIT TYPE OF INSURANCE INgp'WVD POLICY NUMBER P66cy EFF ( / Y �, LIMITS
ABILITY E6CH OCCURRENCE $
00,000
I CLAIMS-MADE X IIOCC R X X 1000025506181 0610112018 06/01/2019 DAMAGE
AMA ET OR s�ur°���) � 1,100,000
A X COIGENERAL.
X CONT
5,000
MED„EXP,(Any,one Person)_ $
PERSONAL a ADV INJURY__ S 1,000,000
GEN1 AGGREGATE, . LIMIT APPLIES PER: „GENE,RAL AGGREGATE
2,000,000
POLICY XIECLOC 2'000,000JT DUCT -
OT&ER
I
A AU„OMOBILE LIABILITY (E�RMa��tlalq;yp45GN�.�q,.)=n bM'l1T $ 1,006-,-6-0-0
000
X
ANY AUTO SCHEDULED X X 1000198549181 06/01/2018 06101/2019 BODILY INJURY(Pe pemgn) $
AUTOS ONLY
. AUTOS BODILY INJURY(,Peraccident)
XAIX UOTOOLPROPERTYAMAGEUTOS ONLY ANYY raccident) $$
$
,�_ .. UMBRELLA LIAB X OCCUR ..m.�................................................... EACH OCCURRENCE------ -$ 1,000,000
mITITm,mIT.mmX EXCESS,LI„�RETENTION$ CLAIMS-MADE 1000565134181 06/01/2018 0610112019 AGGREGATE �� $ „11000,00,0
DED
ATION
PER
A ANDEMPLO ERS'LIABILITY YI,NI 1000002214 06/01/2018 06/01/2019 X u_EACH$TAILITE, aENT EP 1,000,0001$ 1'000'00 011
ANY�M IC R MEM ory in H,EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE I .I NIA X E L DISEASE-EA EMPLOYEE.$ ...............ry.°tl00,000
If yes,describe underDESCRIPTION
ry.00n�no
......._. E...., _mEASE-POLICY LIMIT $
F ERATI N below ,,,,DIS,,,,,,,,,,,E,,,,,,, LI
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLESACORD 101,Additional Remarks Schedule,may be attached it morns ace Is required)
RE:Excel Job#5577;Project#PW 18-08;Main�tr'eet Bollards Project. glalpwv/auai'wv wcwv/agg
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.
..............-mm.................................................................................... _._,.....................................................................rr www .
CE'R'TIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ci of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City 9 ACCORDANCE WITH THE POLICY PROVISIONS.
City Clerk
350 Main Street .................
EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE
.._........................w..............
ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID:PALP,INC. CPALIVIER
LOC#:
AC"REP
ADDITIONAL REMARKS SCHEDULE Page 1 of 1
...............
AGENCY NAMED INSURED
Pa'W Inc.DBA Excel Paving Company;GAP Equipment,LLC
223 Lemon Avenue
POLICY NUMBER Long Beach,CA 90806
SEE PAGE 1
CARRIER NAIC CODE
SEE PAGE 1 �SEE P 1 EFFECTIVE DATE:SEE PAGE 1
ADDITIONAL REMARKS
...........
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: APPID,25 FORM TITLE: Certificate of Liability Insurance
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....................
ACORD 101 (2008/01) @ 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
Amendment of Limits of Insurance
(Per Project, Per Location or
Per Project and Per Location Limit)
Policy Number: 1000025506181 Effective Date: 06/01/2018 at 12:01 A.M.
Named Insured: Palp, Inc. DBA Excel Paving Company
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
It is hereby agreed as follows:
I. The Limits of Insurance shown in the Declarations are deleted in their entirety and replaced by
the following:
1.
Your policy includes either i) a Per Project Limit, ii) a Per Location Limit or iii) a Per Project
and Per Location Limit. Please select only one of the following:
[X] Per Project Limit $ 2,000,000
[ ] Per Location Limit $
[ ] Per Project and Per Location Limit $
THIS ENDORSEMENT IS VOID IF:
NONE OF THE BOXES LISTED ABOVE ARE CHECKED; OR
MORE THAN ONE OF THE BOXES LISTED ABOVE ARE CHECKED; OR
ONLY ONE OF THE BOXES LISTED ABOVE IS CHECKED BUT IS UNACCOMPANIED
BY AN ASSOCIATED DOLLAR AMOUNT,
Manuscript
Page 1 of 4
Copyright© C.V.Starr&Company and Starr Indemnity&Liability Company. All rights reserved.
Includes copyrighted material of ISO Properties,Inc.,used with its permission.
2.
General Aggregate Limit $10,000,000
Each Occurrence Limit $1,000,000
Products-Completed Operations Aggregate Limit $2,000,000
Personal &Advertising Injury Limit $1,000,000
Damage to Premises Rented to You $100,000
Medical Expense Limit $ 5,000
II.. SECTION III— LIMITS OF INSURANCE is deleted in its entirety and replaced by the
following:
1. The Limits of Insurance and the rules below fix the most we will pay regardless of the
number of:
a. Insureds;
b. Claims made or"suits" brought; or
c. Persons or organizations making claims or bringing "suits".
2. The General Aggregate Limit is the most we will pay under Coverages A, B, and C
combined for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages because of "bodily injury" or
"property damage" included in the products-completed operations hazard"; and
c. Damages under Coverage B.
regardless of the number of projects or"locations."
3. The Products-Completed Operations Aggregate Limit is the most we will pay under
Coverage A for damages because of "bodily injury" and "property damage" included in
the "products-completed operations hazard".
4. Subject to Paragraph 2 above, the Personal and Advertising Injury Limit is the most we
will pay under Coverage B for the sum of all damages because of all "personal and
advertising injury"sustained by any one person or organization.
5. Subject to Paragraph 2 or 3 above, whichever applies, the Each Occurrence Limit is the
most we will pay for the sum of:
a. Damages under Coverage A; and
b. Medical expenses under Coverage C
because of all "bodily injury"and "property damage" arising out of any one "occurrence".
6. Subject to Paragraph 5 above, the Damage to Premises Rented to You Limit is the most
Manuscript
Page 2 of 4
Copyright© C.V.Starr&Company and Starr Indemnity&Liability Company. All rights reserved.
Includes copyrighted material of ISO Properties,Inc.,used with its permission.
we will pay under Coverage A for damages because of "property damage" to any one
premises, while rented to you, or in the case of damage by fire, while rented to you or
temporarily occupied by you with permission of the owner.
7. Subject to Paragraph 5 above, the Medical Expense Limit is the most we will pay under
Coverage C for all medical expenses because of "bodily injury" sustained by any one
person.
8. Subject to Paragraphs 2,4, 5, 6, and 7 above, the Per Project Limit is the most we will
pay under Coverages A, B, and C combined for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages because of"bodily injury"or
"property damage" included in the products-completed operations hazard"; and
c. Damages under Coverage B.
arising out of any single Project.
9. Subject to Paragraphs 2,4, 5, 6, and 7 above, the Per Location Limit is the most we will
pay under Coverages A, B, and C combined for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages because of"bodily injury" or
"property damage" included in the products-completed operations hazard"; and
c. Damages under Coverage B.
arising out of any single"location."
10. Subject to Paragraphs 2,4, 5, 6, and 7 above, the Per Project and Per Location Limit is
the most we will pay under Coverages A, B, and C combined for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages because of"bodily injury"or
"property damage" included in the products-completed operations hazard"; and
c. Damages under Coverage B.
arising out of any single Project or"location," as applicable.
The Limits of Insurance of this Coverage Part apply separately to each consecutive annual
period and to any remaining period of less than 12 months, starting with the beginning of the
policy period shown in the Declarations, unless the policy period is extended after issuance
for an additional period of less than 12 months. In that case, the additional period will be
deemed part of the last preceding period for purposes of determining the Limits of Insurance.
III. SECTION V—DEFINITIONS is amended to include the following:
"Location" means premises involving the same or connecting lots, or premises whose
connection is interrupted only by a street, roadway, waterway, or right-of-way railroad.
Manuscript
Page 3 of 4
Copyright© C.V.Starr&Company and Starr Indemnity&Liability Company. All rights reserved.
Includes copyrighted material of ISO Properties,Inc.,used with its permission.
All other terms and conditions of this policy remain the same.
Signed for STARR INDEMNITY& LIABILITY COMPANY
Charles H. Dangelo;�President Nehemiah E.Ginsburg, General counsel
Manuscript
Page 4 of 4
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: 1000025506181 COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
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
g O
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 1. All work, including materials, parts or
include as an additional insured the person(s) or equipment furnished in connection with such
organization(s) shown in the Schedule, but only work, on the project (other than service,
with respect to liability for "bodily injury", "property maintenance or repairs) to be performed by or
damage" or "personal and advertising injury" on behalf of the additional insured(s) at the
caused, in whole or in part, by: location of the covered operations has been
1. Your acts or omissions; or completed;or
2. The acts or omissions of those acting on your 2. That portion of 'your work" out of which the
behalf; injury or damage arises has been put to its
in the performance of your ongoing operations for intended use by any person or organization
the additional insured(s) at the location(s) other than another contractor or subcontractor
engaged in performing operations for a
designated above. principal as a part of the same project.
However:
1. The insurance afforded to such additional C. With respect to the insurance afforded to these
insured only applies to the extent permitted by additional insureds, the following is added to
law; and Section III—Limits Of Insurance:
2. If coverage provided to the additional insured is If coverage provided to the additional insured is
required by a contract or agreement, the required by a contract or agreement, the most we
insurance afforded to such additional insured will pay on behalf of the additional insured is the
will not be broader than that which you are amount of insurance:
required by the contract or agreement to 1. Required by the contract or agreement;or
provide for such additional insured. 2. Available under the applicable Limits of
B. With respect to the insurance afforded to these Insurance shown in the Declarations;
additional insureds, the following additional whichever is less.
exclusions apply: This endorsement shall not increase the
This insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the
"property damage"occurring after: Declarations.
CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER: 1000025506181 COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
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
—.---__..... q p .t..��...................................
will be shown in the Declarations.
n ormation required to complete this Schedule, i not shown abovem m 1
A. Section II — Who Is An Insured is amended to required by the contract or agreement to
include as an additional insured the person(s) or provide for such additional insured.
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or B. With respect to the insurance afforded to these
"property damage" caused, in whole or in part, by additional insureds, the following is added to
"your work" at the location designated and Section III—Limits Of Insurance:
described in the Schedule of this endorsement If coverage provided to the additional insured is
performed for that additional insured and included required by a contract or agreement,the most we
in the"products-completed operations hazard". will pay on behalf of the additional insured is the
However: amount of insurance:
1. The insurance afforded to such additional 1. Required by the contract or agreement; or
insured only applies to the extent permitted by 2. Available under the applicable Limits of
law; and Insurance shown in the Declarations;
2. If coverage provided to the additional insured is whichever is less.
required by a contract or agreement, the
insurance afforded to such additional insured This endorsement shall not increase the applicable
will not be broader than that which you are Limits of Insurance shown in the Declarations.
CG 20 37 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: 1000025506181 Effective Date: June 1, 2018 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 pN
Charles H. Dafrgelo, President Nehemiah E. Ginsburg,GenerallUcounsel
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: 1000025506181 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.
.......
............................................................................ ww.
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
dr
Starr Indemnity & Liability Company
Y
Dallas, TX 1-866-519-2522
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy Number: 1000198549181 Effective Date: 06/01/2018
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"
I. 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
Charles H. D,a ngelo,"Pres ide tit Nehemiah E. Ginsburg, General(/Counsel
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: 1000198549181 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: 6/1/2018
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.
.....................................................................w..................... .........
Information reaLlired to cornolete 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 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1
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: 06/01/2018 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