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Digitally signed by Francine R.
<br />FrancineR.Villareal Villareal
<br />PALP, INC. ""•`.
<br />`""."".""':";1EAIW
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />6/161276/2021
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsemen s .
<br />PRODUCER
<br />CONTNAMZACT
<br />The Wooditch Company Insurance Services, Inc.
<br />1 Park Plaza, Suite 400
<br />Irvine, CA 92614
<br />PHONE No, Extl: (949) 553-9800 (A//C, No):(949) 553-0670
<br />-MAIL
<br />s:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Executive Risk Indemnity, Inc.
<br />35181
<br />INSURED
<br />INSURER B:Federal llnsuranceCompany
<br />20281
<br />INSURER C :
<br />Palp, Inc. DBA Excel Paving Company; GAP Equipment, LLC
<br />_
<br />INSURER D :
<br />2230 Lemon Avenue
<br />Long Beach, CA 90806
<br />NSURER E :
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: RFVISIr1N NIIMRFR• 1
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />ADDLSUBR INSD
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />X
<br />X
<br />54310180
<br />6/112021
<br />6/112022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGES RENT A sug-c ante
<br />100,000
<br />MED EXP An one arson
<br />5,000
<br />PERSONAL &ADV INJURY
<br />1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY jEeT 1:1 Lac
<br />GENERALAGGREGATE
<br />2,000,000
<br />GENT
<br />PRODUCTS - COMP/OP ADD
<br />2,000,000
<br />EMPLOYEE BENEFI
<br />11000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />$
<br />X
<br />BODILY INJURY Per erson
<br />$
<br />ANY AUTO
<br />X
<br />X
<br />54310182
<br />61112021
<br />61112022
<br />BODILY INJURY Per accident
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X
<br />gqOPERTY AMAGE
<br />Peraccitlent
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />Qaandatory in NH)EXCLUDED?
<br /># yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />W10181
<br />61112021
<br />611/2022
<br />PER OTH-
<br />XSTAT ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L DI$EASE-EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE- POLICY LIMB
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached ITmore space is required)
<br />RE: Excel Job #5770; Agreement #A-2020-245-04; RFP# 20.106, RFCA 121112020, Item #09; On -Call Emergency Asphalt Concrete, Concrete and Storm Drain
<br />Repair Services. glaipwv/auaiwirlwcwv
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as Additional Insureds as respects General Liability and Auto
<br />Liability per attached endorsements.
<br />This Insurance shall apply as Primary and Non -Contributory per attached endorsement.
<br />Waiver of Subrogation for General Liability, Auto Liability and Workers' Compensation: See Attached Endorsements.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CityTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th floor
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />ltlekMmagarmltDivision
<br />�'3� REVIEWED&APPROVED BY:
<br />,
<br />Vii ., iurJ� FMI.r�:.0 2. V tL Tuf
<br />ACORD 25 (2016103) ©1988-2015 ACORD C
<br />The ACORD name and logo are registered marks of ACORD Risk Mlanagrmrnt Analyst
<br />
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