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AGENCY CUSTOMER ID: PALPINC-01 <br /> LOC#: <br /> ACo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> The Baldwin Group West,LLC Palp Inc.DBA Excel Paving <br /> 2230 Lemon Avenue <br /> POLICY NUMBER Long Beach CA 90806 <br /> CARRIER NAIC CODE <br /> EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br /> RE:Excel Job#5917;On-Call Emergency Asphalt and PPC Services for the City of Santa Ana.gWpwv/auaipwv/wcwv The City of Santa Ana,its officers, <br /> employees,agents,volunteers and representatives are included as Additional Insureds as respects General Liability,Auto Liability,and Professional Liability per <br /> attached endorsements. This Insurance shall apply as Primary and Non-Contributory per the attached endorsements. Waiver of Subrogation for General <br /> Liability,Auto Liability,Professional Liability and Workers'Compensation:See Attached Endorsements. <br /> ACORD 101 (2008101) Q 2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />