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EXCEL PAVING CO. 15-6836 & 15-6452 REVIEWED BY: <br />I se G��6 <br />EUNICE HEREDIA (PG 1 OF 7) <br />PALPINC-01 EVELASCO <br />DATE MMIDDttYYY '. <br />A�"✓de2a CERTIFICATE OF LIABILITY INSURANCE <br />6/23/2015 I <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 13Y 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />The Wooditch Company Insurance Services, Inc. <br />1 Park Plaza <br />Suite 400 <br />Irvine, CA 92014 <br />NTA T <br />NAME. <br />PpoNE I948 563-9000 PAx <br />A,C Na.Ext:1 ) Alc Na: (949 553-0670 <br />IL <br />ADDRESS: <br />INSURaRS AppORDINO CtlVERADE NAICe <br />NSURRRA: Gid Republic General Ins. Corp 24139 <br />06/0112016 <br />INSURED <br />INSURER B <br />INISURERC: <br />Palp, Inc. dba Excel Paving Company <br />INSURER O: <br />2230 Lemon Avenue <br />Long Beach, CA 90806 <br />INSURER R: <br />INSURER F: <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY a JECT R LOC <br />OTHER: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRER: 1 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THETERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY FIIAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR <br />TYPE OF INSURANCE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza <br />POLICY NUMBER <br />MMIDD/TYVV <br />rdbDIYVYYL <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MAGE occua <br />X <br />Al CG50211611 <br />I <br />j O6Po1/2015 <br />06/0112016 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />RENTED <br />PREMISES Do aaou" <br />$ _ 1.00,006 <br />MED EXP Anyone areon) <br />$ 6,000 <br />PERSONAL&ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY a JECT R LOC <br />OTHER: <br />ORNERALAGGREGATE <br />$ 2,000,000 <br />PROOUCIS-COMP/OP AGG <br />� 2,000,100 <br />$ <br />A <br />AUTOMOBILELIABILPY <br />X <br />X <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUT05 <br />I IIREC AUTOC X NON- 'NNEO UTOS <br />A1CA50211511 <br />06/01/2015 <br />06/0112016 <br />COMBINED INOTE IMIT <br />Ea acddanl <br />$ 1,000,000 <br />BODILY INJURY (Parparson) <br />$ <br />BODILY INJU RY(Per ecalden0l$ <br />I' <br />P OP.E den DAMAGE <br />UMBRELLA LIAR <br />EXCESS UAB <br />OCCUR <br />GL11MS-MADE <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />$ <br />DEO <br />RETENTION$ <br />3 <br />A <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY <br />ANY PROPRIETORWARTNERIEXECUIIVE YIN <br />CFFICERMEMHER EXCLUDED? � <br />(Mandatory In NH) <br />If yyes, describe undor <br />OE&C PTION OF OPERATIONS helvre <br />N/A <br />1CW50211512 <br />06101(2015 <br />06101/2016 <br />PER DTFI- <br />X STATUTE E <br />E.L.BACHACCIDEW <br />$ 1,000,000'-: <br />111.OISEASE.EAEMPLOYE-1 <br />$ 1,000,0001. <br />EL.DISEASE- POLICY LIMIT <br />$ 1,000,006; <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Rema,Ns Eshedule, maybe atlocimd It more space Is required) <br />RE: Excel Job 46260; Residential Street Repalr(15.6836) and Wilshire Avenue and Bosshard Ave Water Main (16-6462). glaip/manual <br />City of Banks Ana, Its officers, employees, agents and volunteers are Included as Additional Insureds as respects General Liability per attached endorsement. <br />This insurance shall apply as Primary and Non -Contributory per attached endorsement. <br />r:FRTIFIr:ATF l4nI DFP PAMr:Fi I ATITIM <br />O 1988-2014 ACORD CORPORATION. All rights reservod. <br />ACORD 26 (2914/01) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES EE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 Civic Center Plaza <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Ross Annex (M , 2 2) <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />O 1988-2014 ACORD CORPORATION. All rights reservod. <br />ACORD 26 (2914/01) The ACORD name and logo are registered marks of ACORD <br />