|
PALPINC-01 AGARCIA
<br />'ARa
<br />� CERTIFICATE OF LIABILITY INSURANCE
<br />DaTEIMMIDDNYWI
<br />$12912015
<br />THIS CERTIFICATE IS ISSUED ASA 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(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 andorsament(a).
<br />PRODUCER
<br />The Woodltch Company Insurance Services, Inc.
<br />1 Park Plaza
<br />Suite 400
<br />Irvin¢, CA 92614
<br />CONTACT
<br />NAME:
<br />PHONE -CAT
<br />AT 949 553.0670
<br />.1AIS.NUFas1:.(. _._ �._—__�.__�.� .IA!9,. Nul,_JU9J
<br />EMAIL
<br />gDORE_ss:
<br />INSURER(S) AFFORDING COVERAGE NAICN
<br />INSURhRA:GId Re ublic General Ins. Cor
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />INSUREDINSURER
<br />a:
<br />!J�
<br />INSURER c_
<br />Palp, Inc., dba: Excel Paving Company
<br />INSURER Or
<br />CLAIMS -NAPE l"I OCCUR
<br />__.
<br />2230 Lemon Avenue
<br />Long Beach, CA 90806
<br />wsuREa E:
<br />05Poi12tl15
<br />INSURER FI
<br />p EM0Es Ea Cccurc nca $ 1'6,800
<br />_.,. __-1—__._._...,_._._._._—
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<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 RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR. MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECTTOALLTHETERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSID
<br />me
<br />POLICY NUMBER
<br />POLIO EFF
<br />MMIDORYYY
<br />P IC EXP
<br />MMUDDIYYYyl
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE ',$ 1,000,000
<br />CLAIMS -NAPE l"I OCCUR
<br />__.
<br />X
<br />A1CG50211511
<br />05Poi12tl15
<br />6510112618
<br />p EM0Es Ea Cccurc nca $ 1'6,800
<br />_.,. __-1—__._._...,_._._._._—
<br />MEDEXP(AnyonePeew) '',$ 5,000
<br />PERSONAL "DV INJURY ''� 8 _ 1,000,000
<br />TTM.2,"',000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />POLICY jEO LOC
<br />PRODUCTS-COMPIOP AGO $ 2,800,000
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 1,66',"'
<br />Ea acddenl
<br />A
<br />X- ANY 'UTO
<br />A1CA50211511
<br />'6)'112'15
<br />1161'1/2016
<br />BODILY INJURY(PerperSonl �!g
<br />_
<br />. ALLOWNED�_..I SCHEOULEO
<br />AUTOS AUTOS
<br />BODILY INJURY (Per acddenOlS
<br />NOWOWNEO
<br />X HIRED AUTOS X AUTOS
<br />PROPERTYDAMAGE
<br />Perecdder -$
<br />r
<br />'5
<br />H
<br />UMBRELLA LIAR j OCCUR
<br />EACH OCCURRENCE S
<br />AGGREGATE $
<br />EXCESS LIAR CLAIMS -MADE
<br />_$
<br />DEO ! I RETENTION$
<br />WORKERS COMPENSATION
<br />XSTATUTE ERN
<br />AND EMPLOYERS' LIABILITY YIN
<br />A
<br />ANY PROPRIE(ORIPARTNERIEXECUTIVE
<br />A1CW56211512
<br />'6101@015
<br />66101!2016
<br />E.L. EACH ACCIDENT I$ 1,0'0,006
<br />OFFICERIMEMSER EXCLUDED7 C
<br />(Mandatory in NH)
<br />NIA
<br />EA. DISEASE- EA EMPLOYEE$ 1.,000,000
<br />Ifyas,deacribeunder
<br />DESCRIPTION OF OPERATIONS bebw
<br />EL. DISEASE -POLICY LIMIT 5 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tat, ANUltionel Remarks Schedule, maybe attached Irmme space is required)
<br />RE: Excel Job 45251; Project #14.7516 and #15.7514; Residential Street Repair FY 13114 and 14115, gfalimanual
<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 />CERTIFICATE. HOLDER CANCELLATION
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />r
<br />i
<br />EXCEL PAVING COMPANY PROJECTS 14-7516 & 15-7514; REVIEWED BY:., / �f� .,EUNICE HEREDIA (PG 1 OF 6)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 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 />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />r
<br />i
<br />EXCEL PAVING COMPANY PROJECTS 14-7516 & 15-7514; REVIEWED BY:., / �f� .,EUNICE HEREDIA (PG 1 OF 6)
<br />
|