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Insurance - Excel Paving - 2014-08-25OP ID: MEL ,164 ° CERTIFICATE OF LIABILITY INSURANCE DA E 08/125/14 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 terns 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 Ileu of such endorsements . PRODUCER Phone: 949 -553 -9800 The Wooditch Company Insurance Fax: 949553 -067 Services, Inc. 1 Park Plaza, Suite 400 IrVlne, CA 92614 William S. Wood'dch POLICY NUMBER PHONE Ac No E4, AC NA: EMAIL PRODUCE CUSTOMERI r EX INSURERS) AFFORDING COVERAGE NAIC # INSURED Palp, Inc., dba: Excel Paving Company 2230 Lemon Avenue Long Beach, CA 90806 INSURERA:Old Republic General Ins. Corp 24139 INSURER B: 11101/14 INSURERC: $ 1,000,00 NSURERD: $ 100,00 INSURERE: $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 rn\ /FDAGRC rFRTIFIr ATG NI IMDFD, DF,ACIna1 unnnD VD. 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 TYPE OF INSURANCE POLICY NUMBER MIDD F OIDO LIMITS A GENERAL LIABILITY X COMMERCIAL GENERA LIABILITY CLAIMS-MADE O OCCUR X Costa A1CG50211310 11I01/13 11101/14 EACH OCCURRENCE $ 1,000,00 PREMISES Eaoccurrence $ 100,00 MED EXP (Any one parser) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGRFGAT_ $ 2,000,00 GEN'LAGGREGATE POLICY X LIMIT APPLIES PER'. PR' LCC PRODUCTS - COMP /OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO A'_L OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS RONOWNED AUTOS AlCA50211310 11/01113 11101/14 COMBINED SINGLE LIMIT (Ea seeldanp $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (P =reccident) $ X $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIM MADE EACH OCCURR- -MCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYRROPRIETORIPARTNER/EXECUT/E OFPKERMEMBER EXCLUDED? F1 (Mandatary in NH) It yes, descnbe under Hi O N low NIA Al CW50211310 11/01113 11101/14 X TORY IQIT R E. L. EACH ACCIDENT $ 1,000,00 E. L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMY $ 1 000 0D DESCM"ON OF OPERATIONS I LOCATIONS I VEHICLES Attach ACOM 101, Additional Remark, Schatlule, if more space i, required) Except 10 Days Notice of Cancellation for Non - Payment of Premium. Excel Job #5185; CMSD Job #204; Sewer Manhole Surface Repair Program. Costa Mesa Sanitary District is included as Additional Insured as respects eneral Liability per attached endorsement. glai THIS VOIDS AND SUPERSEDES PREVIOUS CERTIFICATE DATED 08/22/14* rFDTIPIr ATC Nnl nFD rAKUr FI I Anna OO 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD25 (2009/09) The ACORD name and logo are registered marks of ACORD COSTASI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary Dis trict ACCORDANCE WITH THE POLICY PROVISIONS. 628 E. 29th Street AUTHORIZED REP�RESENTATTUE Costa Mesa, CA 92627 OO 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD25 (2009/09) The ACORD name and logo are registered marks of ACORD (NOTEPAD EXCELP1 PAGE 2 I INWIEdS NAME Palp, Inc., dba: OP ID: MEL DATE 09(2$/14 this policy be cancelled before the expiration date, The Wooditch will mail 30 (thirty) days written notice to those Certificate which rem re such action per contract or agreement.* POLICY NUMBER: A -1CG- 502113 -10 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 11 — 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: AICG5021131.0 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