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Insurance - Excel Paving Company 2014-08-25OP ID: ME[ "kwi CERTIFICATE OF LIABILITY INSURANCE DA E 125114 06/25/14 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 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 Phone: 949 -553 -9800 The Wooditch Company Insurance Fax: 949553 -067 Inc. 1 Park Plaza, Suite 400 Irvine, CA 92614 William S. Wooditch PINUAUI H E#: C o: NServices, EM ADDRESS: PRODUCER RIDe: EXCELPt INSURER(S) AFFORDING COVERAGE NAIL* INSURED Palp, Inc., dba: Excel Paving Company 2230 Lemon Avenue Long Beach, CA 90806 INSURERA:Old Republic General Ins. Corp 24139 INSURER B: INSURER C: INSIIRERD: EACH OCCURRENCE INSURER E' A INSURER F X COVERAGES CERTIFICATE NUMBER, REVISION NUMBER: 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. INSR LU TYPE OF INSURANCE Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS. POLICYNUMBER MMC MID LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMSMADE 57 OCCUR X A1C050211310 11/01113 11/01M0. PREMISES Ea occurrence $ 100,00 MED RAP (Any we parson) $ 5,00 PERSONAL d ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS - COMP /OP AGO $ 2,000,00 POLICY X PRO LOC $ A AUTOMOBILE X LIABILITY ANY AUTO A1CA50211310 11/01/13 11/01/14 COMBINED SINGLE LIMIT (Ea accdent) $ 1,000,00 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DANAGE (Per xNdeni) $ X NON -ONMED AUTOS $ UMBRELLA LIAB. OCCUR EACI I OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNERI ECUMVE Y� OFFICERMEMBER EXCWDED9 N/A Al CW50211310 19/01/13 11101/14 X T RV I ITS P. EL. EACH ACCIDENT $ 1,000,00 EL. DISEASE - EA EMPLOYEE $ 1,000,00 (Mandatory In NH) If ON descnO, under D SC IP ON R TI ONS bal � F I. D19FASF - POLICY LIMIT $ 11000.00t DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Except 10 Days Notice of Cancellation for Non - Payment of Premium. Excel Job #5185; CMSD Job #204; Sewer Manhole Surface Repair Program. osta Mesa Sanitary District is included as Additional Insured as respects eneral attached endorsement glai THIS VOIDS AND UERSEDESEV2 USCERTIFICATE DATED 08/22/14* r-CRTICIr-ATC uni rl rAIJr -CI I ATlnu COSTASI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS. 628 E. 29th Street ALITHDRIZEE�D, REPRESENTATIVE Costa Mesa, CA 92627 O 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD EXCELPI PAGE 2 NOTEPAD INSURED'S NAME Palp, Inc., dba: OP ID: MEL DATE 06125114 *Should this policy be cancelled before the expiration date, The Wooditoh Company will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.* POLICY NUMBER: A-1 CG-502113-1 0 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 Organization(s) Location And Description Of Completed Operations WHERE REQUIRED BY WRITTEN CONTRACT, BUT ONLY WHEN COVERAGE FOR COMPLETED OPERATIONS IS SPECIFICALLY REQUIRED BY THAT 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations: whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: Al CG50211310 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) Locations Of Covered Operations 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or 'personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work including materials parts or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However, 2• 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed, or That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the Insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance; If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13