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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