Loading...
HomeMy WebLinkAboutPALP, INC. DBA EXCEL PAVING CO. (2) 0: pw t (1) INSURANCE NOT ON FILE M.06-4- (02-) WORK MAY N0T PROCEED A-2023-076-03A CITY CLERK DATE:J UN 1 7 2026 MAYOR CITY MANAGER Valerie Amezcua �! Alvaro Nunez MAYOR PRO TEM f CITY ATTORNEY David Penaloza Sonia R.Carvalho COUNCILMEMBERS Phil Bacerra +� CITY CLERK Johnathan Ryan Hernandez Jennifer L.Hall Jessie Lopez Thai Viet Phan Benjamin Vazquez CITY OF SANTA ANA PUBUC WORKS AGENCY 20 Civic Center Plaza I PO Box 1988 Santa Ana,California 92702 www.santa-ana.ora April 21,2026 Palp,Inc.,dba Excel Paving Co. Attn: Curtis P. Brown III,President 2230 Lemon Ave. Long Beach,CA 90806 Re. Extension of A reement No.A-2023-076-03 to iprovide on-call Emergence as halt and PCC Services Pursuant to Section 3 ("Term")of the above-referenced Agreement,entered into by Palp,Inc., dba Excel Paving Co. and the City of Santa Ana, which commenced on May 2, 2023, the parties hereby exercise their option to extend the term of the Agreement for an additional one(1)year through May 1,2027.Any insurance certificates are required to be extended and/or renewed to cover this extension.All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, fo R ,P.E. MQ Acting Executive Director, Public Works Agency CITY OF ANTA A ATTEST vary Nufzcz J er . all City Manager City C1 k APPROVED AS TO FORM CONTRACTOR UFA - K�ie Nellesen y_ David A.Drukker Assistant City Attorney Title: Vice President SANTA ANA CITY COUNCIL Valerie Amezcua David Penaloza Thai Viet Phan Benjamin Vazquez Jessie Lopez Phil9e tra. Jnhrialhan Ryan Hemandez mayor Mayor Pro -Ward 6 Ward 1 Ward 2 Ward 3 Ward R Ward 5 yy3iJ3S,bcuarc3santa 3na.om daenaluzardtsanta-ana.am lnher(deaanla-ana.ora byazoueziDsania-ana.nre lessfeloaszDsantaana.oro phecerra[dsanta-ana.om a andez santa. .a A��0 DATE IMMIDDIYYYY) AC� CERTIFICATE OF LIABILITY INSURANCE F612 312 0 2 5 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(les)must have ADDITIONAL INSURED provisions or 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). PRODU NAMEI CER CONTACT The Baldwin Group West, LLC PHONE Karlee Crowe FAX 15901 Red Hill Ave, Ste 100 1 N, 11714 505-7000 arc No: 714 573-1770 Tustin CA 02780 EDDRii Karlee.Crowe@baldA(in.com INSURERS AFFORDING COVERAGE NAIC# Lice ee#:OF69771 INSURERA:BITCO General Insurance Cor or 20006 INSURED PALPINC-01Pal INSURERB:Great American Insurance Coma 16691 223 0 Lemon Avenue Inc, DBA Excel Paving INSURERC:Indian Harbor Insurance Com an 36940 23 Long Beach CA 90806 INSURER D:SlriusPoint Specialty Insuranc 16820 INSURERS:RSUI Indemnity Company 22314 INSURER F: COVERAGES CERTIFICATE NUMBER.252538607 REVISION NUMBER: THIS IS TO CERTIPY 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. ILTK TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER MMIDDrVYYY MMIDD1YYYY LIMITS A X COMMERCIALGENFRALLIABILITY Y Y CLP3768664 6/1/2025 611/2026 EACHOCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMA P T RENTED PREMISES Ea occurrence $300,000 MED EXP(Any one arson) $10,000 PERSONAL&ADV I NJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY[K PE'' LOC PRODUCTS-COMPIOPAGG $2,000,000 OTHER: EB Aggregate $2,000,000 A AUTOMOSILE LIABILITY Y Y CAP3758662 611/2025 6/1/2026 COMBINED SINGLELIMIT $1,000,000 Ea accdent X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY pAMAGE AUTOS ONLY AUTOS CNLY Per accident $ B UMBRELLALIAB X OCCUR TUE341439505 6/1/2025 6/112026 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DIED RETENTION$ $ A WORKERS COMPENSATION Y WC 3758666 6/1/2025 6MI2026 X PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANYPROPRIETORJPARTNER/EXECUTIVE ❑ N 1 A E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $1,000,000 C Professional Liability CPPL D0002424 00 6/1/2025 6!1/2026 Occurance 2,000,000 D Polluifon Liability CPPL D0002424 00 6/1/2025 6/1/2026 Occurance/Aggregate 5,000,000 E 2nd Layer of Excess NHA606876 611/2025 6/1/2026 XSO-JAgg 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) The Certificate Holder is listed as additional insured for the General Liability and Auto Liability.See Attached Endorsements, This insurance shall apply as Primary and Nan-Contributory per attached endorsement. Waiver of Subrogation for General Liability,Auto liability and Workers'Compensatlon:See Attached Endorsements, Cancellation: 'Except 10 Days Notice of Cancellation for Non-Payment of Premium. "Should this policy be cancelled before the expiration date a 30(thirty)days written notice to those Certificate Holders which require such action per contract Or agreement,* See Attached... CERTIFICATE HOLDER -AppIOVFtr CANCELLATION By TuTTan Nguyen at 3 ff0 prn;'Jun 73;'7t173 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tu Tfa n Digitally signed by ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Tu Tran Nguyen Public Works Agency M-83 bate;2025.05.23 20 Civic Center Plaza Nguyen 15,OOk43-07'00' AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 Oa 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PALPINC-01 LOC#: ACo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED The Baldwin Group West,LLC Palp Inc.DBA Excel Paving 2230 Lemon Avenue POLICY NUMBER Long Beach CA 90806 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE 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, employees,agents,volunteers and representatives are included as Additional Insureds as respects General Liability,Auto Liability,and Professional Liability per attached endorsements. This Insurance shall apply as Primary and Non-Contributory per the attached endorsements. Waiver of Subrogation for General Liability,Auto Liability,Professional Liability and Workers'Compensation:See Attached Endorsements. ACORD 101 (2008101) Q 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IL 00 17 1198 C om" m iCY cmu7 ow All Coverage Parts included in this policy are subject to the following conditions. A Cancellation K Give you reports on the conditions we find; 1. The first Named Insured shown in the Dedara and tions may cancel this policy by rrsailing or deliver c. Recommend changes. ing to us advance written notice of cancellation. 2 We are not obligated to make any inspections, 2 We may cancel this policy by mailing or delivering surveys, reports or recommendations and any to the first Named Insured written notice of can- such actions we do undertake relate only to in- cellation at least: surability and the premiums to be charged.We do a 10 clays before the effective date of cancella- not make safety inspections. We do not under- tion if we cancel for nonpayment of prenlum; take to perform the duty of any person or organi- or nation to provide for the health or safety of work to 30 daysbefore the effective date of cancella- work- ers or the public. And we do not warrant that conditions: tion if we cancel for any other reason. 3. We will mail or deliver our notice to the first a Are safe or healthful;or Named Insureds last mailing address Imown to b. Comply with laws, regulations, codes or stan- us. dards. 4ti Notice of cancellation will state the effective date 3. Paragraphs 1. and 2 of this condition apply not of cancellation. The policy period will end on that only to us, but also to any rating, advisory, rate date service or similar organization which makes in- surance6. If this policyis cancelled, we will send the first mandat inspections, surveys, reports or recorrF Named nured any premium refund due. If we Paragraph 2 of this condition does not t cancel, the refund will be pro rata. If the first g apply o Named Insured cancels, the refund may be less any inspections, surveys, reports or reoommen- than pro rata. The cancellation will be effective dations we may make relative to certification, un- even if we have not made or offered a refund. der state or rrunicipal statutes, ordinances or regulations, of boilers, pressure vessels or eleva- 6. If notice is. mailed, proof of mailing will be suffi- tors. dent proof of notice. E � E Fmnlurt�s The first Named Insured shown in the Declarations: This policy contains all the agreements between you 1, Is responsible for the of allpremiums, and us concerning the insurance afforded. The first pay�t Named Insured shown in the Declarations is author and - ized to make changes in the terms of this policy with 2 1MII be the payee for any return premiums we our consent. This policy's terms can be amended or pay.. waived only by endorsement issued by us and made F. Transfer Of Your Refits And Duties Under This a part of this policy. Policy C Ecaminattion Of Your Books And Records Your rights and duties under this policy may not be M may examine and audit your books and records transferred without our written consent except in the as:they relate to this policy at any time during the case of death of an individual named insured. policy period and up to three years afterward. If you die,your rights and duties will be transferred to Ia. Inspections And Surveys your legal representative but only while acting within 1. We have the right to: the scope of duties as your legal representative. Until your �dre anyone Make inspections and surveys at anytime; ig proper to 'crycast�custody property will have your rights and duties but only with respect to that property. IL 00171198 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0 BITCO GENERAL INSURANCE CORPORATICN BITCO NATIONAL INSURANCE COMPANY EARLY NOTICE OF CANCElLAnON PROVIDED BY US THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVED®UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM Common Policy Conditions,A Cancellation,2.is replaced by the following: 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. TEN ( 10 ) days before the effective date of cancellation if we cancel for nonpayment of premium;or b. SIXTY ( 60 ) days before the effective date of cancellation if we cancel for any other reason. Named Insured: PALP, INC. DBA EXCEL PAVING COMPANY Policy Number: CAP 3758662 Endorsement No.: Policy Period: 06-01--25 to 06-01-26 Endorsement Effective Date: Producer's Nam: THE BALDWIN GROUP SOUTHEAST,LLC Producer Number: 0006686 AUTHORIZED REPRESENTATIVE DATE CA-5370(01/22) POLICY NUMBER CAP 3758662 COMVERCIALAWTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GNAMD INSURED FOR COVERED AUTOS UABI UTY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRI ER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are"insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Nand h1SUF8d: PALP INC. DBA EXCEL PAVING COMPANY Endorsement Effective Date: P 6/01./2 0 2 SCHEDULE Name Of Pors*s)Or Organlxation(s): Any person or organization for whom the named insured has agreed by written "insured contract" to designate as an additional insured subject to all the provisions and 1 i mi tati ons of this policy. Information required to axTplete this Schedule, if not shown above,will be shown in the Declarations. Each person or organization shown in the Schedule is an "Insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph Al. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph 110:2 of Section - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 0 Insurance Services Office, Inc.,2011 Page 1 of 1 POLICY NUIVRER: CAP 3758662 COM EFIgAL AUTO CA04441013 THS ENDOFMIEW CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIC4-ITS OF RECOVERY AGAINST OTHERS TO LIS (WAIVER OF SUBROGAw" This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. NamedlnsUred: PALP INC. DBA EXCEL PAVING COMPANY EndWSe A Effective Date: 0 6/01/2 0 2 5 SCHEDULE Names)Of Person(s)Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT Information required to complete this Schedule,if not shown above,will be shown in the Declarations. The Transfer Of Flights Of Recovery Against Others To Us condition does not apply to the person(s) or organizations) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 0 Insurance Services Office, Inc.,2011 Pagel of 1 BITCO General Insurance Corporation BITCO National Insurance Company ADDITIONAL INSURED—PRIN64RYAND NON-OONTA1113UTORY This endorsement changes the policy. Please read it carefully. This endorsement modifies insurance provided under the following: BUSI NESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "Insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Name of Person(s)or Organization(s): THERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement,) Each person or organization shown in the Schedule is an"Insured"for Liability Coverage, but only to the extent that person or organization qualifies as an "insured' under the Who Is An Insured Provision contained in Section II of the Coverage Form. If the person or organization shown in the schedule qualifies as an "insured' for Liability Coverage, and they have coverage as a first-named insured under another policy,this policy is primary to and non-contributory with that other insurance. All other terms,conditions,and exclusions apply. Named Insured: PALP, INC. DBA EXCEL PAVING COMPANY Policy Number: CAP 3758662 Endorsement No.: Pol icy Period: 06-01-25 to 06-01-26 Endorsement Effective Date: Producer's Name: THE BALDWIN GROUP SOUTHEAST LLC Producer Number: 0006686 AUTHORIZED REPRESENTATIVE DATE AA 5338(01/22) Policy Number: CPT,3758664 THS B\DORSBOWCRANC£STHE POLICY. PLEASE READ ITCAREFU_LY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II — Who Is An Insured is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy for completed operations, but only with respect to liability for"bodily injury" or"property damage" caused, in whole or in part, by 'your work" at the project designated in the contract, performed for that additional insured and included in the"products-completed operations hazard". This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL-4665(01/11) Includes Copyrighted Material of Insurance Services Office With Its Permission Policy Number: CPL3758664 THS ENDORSBVENT CHANGES THE POLICY. PLEASE READ IT CAFEFUL_Y ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, 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 2. The acts or omissions of those acti ng on your behalf; in the performance of your ongoing operations for the additional insured(s) at the project(s) designated in the written contract. 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 equipment furnished in connection with such work, on the project(other than service, maintenanoe 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 2. 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. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL-4667(01/11) Includes Copyrighted Material of Insurance Services Office With Its Permission BITCO GENERAL INSURANCE CORPORATION BITCO NATIONAL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE Iris endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Location(s)of Cornered Operations: Or Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT As required by written contract: Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c.of Section IV—Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured: PALP, INC. DBA EXCEL PAVING COMPANY Policy Number: C LP 3758664 Endorsement No.: Pal icy Period: 06-01-25 to 06-01-26 Endorsement Effective Date: Producer's Name: THE BALDWIN GROUP SOUTHEAST LLC Producer Number: 0006686 AUTHORIZED REPRESENTATIVE DATE GL-5351 (09/21) POLICY NUMBER: CLP 3758664 CONNERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSBIENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGAmcm This endorsement modifies insurance provided under the following: COMMERCIAL.GENERAL LIABI LITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS(COMPLEI ED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s)Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS OPERATING UNDER A WRITTEN "INSURED CONTRACT" WHEN SUCH CONTRACT REQUIRES A WAIVER OF SUBROGATION. lnfom-ation required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Flights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s)prior to loss.This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 0 Insurance Services Office, Inc.,2018 Pagel of 1 BITCD GENERAL INSURANCE CORPORATION BITCO NATIONAL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANC EJ-K ION PROVISION This endorsement modifies insurance provided under the following: WORKERS COMPENSATION AND EMPLOYERS LIABItJ1Y INSURANCE Part Six-Conditions,Item D. Cancellation, Number 2, is changed to read: 2. We may cancel this policy. 1Ne must mail or deliver to you not less than THIRTY (30) days advance written notice stating when the cancellation is to take effect, unless cancellation is for nonpayment of premium, in which event our obligation is mailing not less than TEN (10) days prior to the effective date of cancellation. Mailing notice to you at your mailing address sham in Item 1 on the Information Page will be sufficient to prove notice. Named Insured PALP, INC. DBA EXCEL PAVING COMPANY Policy Number WC 3758665 Endorsement No. Policy Period 06-01-25 to 06-01-26 Endorsement Effective Date: Producer's Name: THE BALDWIN GROUP SOUTHEAST LLC Producer Number: 0006686 AUTHORIZED REPRESENTATIVE DATE WC 99 0314(09/21) BITCO GENERAL..INSURANCE OORPORATION BITCO NATIONAL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT M RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS CONDENSATION AND SVPLOYCRS LIABILITY INSURANCE We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHEN REQUI RED BY WRITTEN CONTRACT. The premium charge for this endorsement is: INCLUDED Named Insured PALP, INC. DBA EXCEL PAVING COMPANY Policy Number WC 3758665 Endorsement No. Policy Period 06-01-25 to 06-01-26 Endorsement Effective Date: Producer's Name: THE BALDWIN GROUP SOUTHEAST LLC Producer Number: 0006686 AUTHORIZED REPRESENTATIVE DATE WC 99 0315(09/21) R*T8*06/09/2024*TUE 3414395 05 00 Great American Insurance Company 205240 GAI 6003 ( Ed . 06 97 ) SCHEDULE A - SCHEDULE OF UNDERLYING INSURANCE Carrier , Policy Number and Period Type of Coverage Limits of Insurance a ) BITCO GENERAL Employers Liability Bodily Injury By Accident INSURANCE CORP . POLICY ; WC 378665 $ 1 , 000 , 000 . each accident 6/ 1125 TO 611126 (PALP , INC . DBAEXC Bodily injury By Disease EL PAVINGCOMPANY) $ 11000 , 000 . policy limit $ 11000 , 000 . each employee b) BITCO GENERAL Automobile/Garage ( } Split Limit INSURANCE CORP . POLICY: CAP 3758662 ( X ) Any Automobile Bodily Injury Liability 6/ 1 /25 TO 611126 ( ) Owned Automobile $ each person Only $ each accident ( ) Specifically Designated Property Damage Liability Automobile $ each accident ( ) Hired Automobile ( X ) Combined Single Limit ( ) Non-owned Automobile $ 1 , 000 , 000 . each accident ( ) Garage L i a b i 11 ty ( ) Garage Operations ( X ) DEFENSE OUTSIDE $ Auto only THE LIMIT each accident $ Other than auto each accident $ Other than auto aggregate ( ) Garagokeepers Liability $ each location GAI 6003 ( Ed . 06197 ) PRO (Page 1 of 2 ) R*T8* 06/09/2024*TUE 3414395 05 00 Great American Insurance Company 205240 Carrier, Policy Number and Period Type of Coverage Limits of Insurance c) ( ) Comprehensive ( ) Split Limit General Liability including Bodily Injury Liability ( ) Products-Complet- $ each occurrence ed Operation Liability $ aggregate ( ) Broad Form Property Damage Liability Endorsement $ each occurrence ( ) $ aggregate ( ) Combined Single Limit $ each occurrence $ aggregate OR OR OR ( X ) Commercial $2 , 000 , 000 . General Aggre- BITCO GENERAL General Liability gate Limit INSURANCE CORP . POLICY: CLIP 3758664 ( X ) Occurrence Form $2 , 000 , 000 . Products-Com- 611 /25 TO 611126 pleted Opera- ( ) Claims-Made Form t i o n Aggre- gate Limit (X) DEFENSE OUTSIDE . ( X ) GENERAL AGGREGATE THE LIMIT APPLIES PER $ 1 , 000 , 000 . Personal and PROJECT Advertising Injury Limit Retroactive Date $ 1 , 000 , 000 . Each Occurrence Limit d) BITCO GENERAL EMPLOYEE BENEFIT $1 , 000 , 000 . EACH EMPLOYEE INSURANCE CORP . LIABILITY POLICY: CLIP 3758664 $100 , 000 . AGGREGATE LIMIT 6/ 1 /25 TO 6/ 1126 BITCO GENERAL EMPLOYERS LIABILITY BODILY INJURY BY ACCIDENT INSURANCE CORP . $1 , 000 , 000 . EACH ACCIDENT POLICY : WC 3758865 611 /25 TO 611126 BODILY INJURY BY DISEASE (GAP EQUIPMENT , LLC) $1 , 000 , 000 . POLICY LIMIT $1 , 000 , 000 . EACH EMPLOYEE GAI 6003 ( Ed . 06197 ) PRO (Page 2 of 2 ) Policy Number: CPPL D0002424 00 S. SUBROGATION-In the event of payment under this Policy,the Company will be subrogated to all of the INSURED's rights of recovery.The INSURED must do whatever is necessary to secure such rights and must not do anything intentional to prejudice such rights.The Company has priority in any recovery.Any monies recovered as a result of subrogation proceedings accrue first to the Company in excess of the Company's total payment and the costs to the Company of recovery,then to the INSURED. Notwithstanding the foregoing,the Company hereby expressly waives such rights of subrogation against an entity where such rights have been waived,in writing, by the INSURED prior to the applicable CLAIM, POLLUTION CONDITION,INDOOR CONTAMINANT CONDITION,or PROFESSIONAL LOSS. T. TERRITORY-This Policy will only apply to a POLLUTION CONDITION or INDOOR CONTAMINANT CONDITION located,CONTRACTING SERVICES or PROFESSIONAL SERVICES rendered,a CLAIM, POLLUTION PROTECTIVE CLAIM,or DESIGN CLAIM made and at all times solely maintained,and ADA AND FHA EXPENSE,BANKRUPTCY LITIGATION EXPENSE, BUILDING INFORMATION MODELING EXPENSE, DISASTER MANAGEMENT COSTS or SUBPOENA EXPENSE for services performed,within the United States,its territories or possessions,Puerto Rica,or Canada. SECTION VII, DEFINITIONS A. ADA AND FHA EXPENSE means reasonable and necessary fees and expenses incurred by counsel,chosen and retained by the Company,to assist the INSURED with their response to a regulatory or administrative action first brought against the INSURED during the POLICY PERIOD by a government agency under the Americans with Disabilities Act of 1990,42 U.S.C.§ 12101 et.seq,or the Fair Housing Act,42 U.S.C.§ 3601 et,seq.,and alleging an act,error,or omission with respect to the rendering of or failure to render PROFESSIONAL SERVICES on or after the Retroactive Date stated in Item 9.of the Declarations and before the end of the POLICY PERIOD. B. ADDITIONAL INSURED means: 1. any person or entity identified as an ADDITIONAL INSURED in an endorsement attached to this Policy;and 2, solely with regard to Coverage A, I and J,when required by a written contract that is signed by the FIRST NAMED INSURED or an ADDITIONAL NAMED INSURED prior to the date the applicable POLLUTION CONDITION or INDOOR CONTAMINANT CONDITION first commences,ADDITIONAL INSURED also includes: a. the client person or entity for whom the INSURED performs CONTRACTING SERVICES pursuant to such written contract;and b. any other person or entity,unrelated to the FIRST NAMED INSURED or any ADDITIONAL NAMED INSURED pursuant to such written contract; The scope and limits of coverage for such person or entity under this Policy will not exceed what is required by the written contract. Coverage is provided solely for the person's or entity's liability arising out of the FIRST NAMED I NSURED's or any ADDITIONAL NAMED INSURED's ownership,maintenance, use,or operation of a COVERED LOCATION, vicarious liability for CONTRACTING SERVICES,or a POLLUTION CONDITION or INDOOR CONTAMINANT CONDITION as applicable.Coverage will only be afforded for such person or entity if that person or entity is named in a lawsuit, petition or regulatory action as a co-defendant with the FIRST NAMED INSURED or any ADDITIONAL NAMED INSURED alleging that it is liable as a result of either the FIRST NAMED INSURED's or any ADDITIONAL NAMED INSURED's ownership,maintenance, use,or operation of a COVERED LOCATION,such person's or entity's vicarious liability for CONTRACTING SERVICES,or a POLLUTION CONDITION or INDOOR 26 O 2022 SirlusPoint Specialty Insurance Corporation, All Rights Reserved. May not be copied without permission. CONTAMINANT CONDITION as applicable.No coverage will be provided under this Policy for an ADDITIONAL INSURED's own negligence or strict liability. C. ADDITIONAL NAMED INSURED means any person or entity identified as such in an endorsement attached to this Policy. D. APPLICABLE LAWS means: 1. any federal,state,commonwealth, local or provincial laws,including but not limited to statutes,rules, ordinances,guidance documents,regulations and all amendments thereto, including risk based corrective action guidance,governing the liability or responsibilities of the INSURED;or 2. in the absence of any of the items in D.I.above,the recommendations of an ENVIRONMENTAL PROFESSIONAL, E. AUTOMOBILE means a land motor vehicle,trailer,semi-trailer, mobile equipment,or off-road motor vehicle, including any machinery or apparatus attached thereto. F. BANKRUPTCY LITIGATION EXPENSE means reasonable and necessary fees and expenses incurred by bankruptcy counsel retained by the INSURED,as applicable, in the making of a DESIGN CLAIM or POLLUTION PROTECTIVE CLAIM that otherwise qualifies for coverage under this Policy but for the fact the applicable DESIGN ENTITY or SUBCONTRACTOR has filed for or been put into bankruptcy under the United States Bankruptcy Code, provided that the applicable DESIGN CLAIM or POLLUTION PROTECTIVE CLAIM,at least in part,results In an allowed claim or a judgment against that DESIGN ENTITY or SUBCONTRACTOR in the INSURED's favor,which is final and no longer subject to appeal. G. BODILY INJURY means: 1. physical injury,disease,sickness,or building-related illness sustained by any person,including death resulting therefrom,and any medical or environmental monitoring costs that are intended to confirm any such physical injury,disease,sickness or illness; 2, court-ordered medical monitoring;or 3. mental anguish,emotional distress,or shock. H. BUILDING INFORMATION MODELING EXPENSE means reasonable and necessary additional expense payable to a third party software consulting company unaffiliated with the INSURED that is not otherwise recoverable by the INSURED,provided such expense arises in response to a CLAIM covered under this Policy and from the loss of or damage to information due to the inherent malfunction of software used in connection with any Building Information Modeling system purchased from a third party vendor that was not modified by the INSURED or on the INSURED's behalf,including but not limited to erroneous calculations or modeling,provided that the malfunction is first discovered after the system has been put to its intended use in the course of actual construction at the JOB SITE,and in any event first discovered during the POLICY PERIOD. I. BUSINESS INTERRUPTION LOSS means: 1. the net profit or loss, before taxes,that the INSURED would have earned or incurred during the INTERRUPTION but for the INTERRUPTION, considering the financial performance of the business before the INTERRUPTION and the financial performance that most likely would have been realized thereafter had no INTERRUPTION occurred; 27 ©2022 SiriusPointSpecialty Insurance Corporation. All Rights Reserved, May not be copied without permission. H. CHOICE OF LAW-In the event that the INSURED and the Company have any dispute concerning, relating to,or arising out of this Policy,including without limitation its formation,coverage provided hereunder,or the meaning, interpretation or operation of any term,condition,definition or provision of this Policy resulting in litigation,arbitration or other form of dispute resolution,the INSURED agrees with the Company that the laws of the State of New York apply without giving effect to any conflicts or choice of law principles, I. CONSENT-Where consent of the Company or the INSURED is required under this Policy,such consent will not be unreasonably withheld,conditioned,or denied. J. DESIGN ENTITY'S INSURANCE—The INSURED must require that each DESIGN ENTITY it utilizes provide written evidence of professional liability insurance. Furthermore,the INSURED must not agree to any limitation of liability from a DESIGN ENTITY with the exception of insurance proceeds without the prior written consent of the Company. K. ENFORCEABILITY-If any part of this Policy is deemed invalid or unenforceable, it does not affect the validity or enforceability of any other part of this Policy. L. INSPECTION-To the extent an INSURED has such rights,the Company is permitted,but not obligated,upon reasonable prior notice to the INSURED,to inspect,audit, review records,sample and/or monitor any JOB SITE, operations,or COVERED LOCATION at any time.Neither this right, nor the actual undertaking thereof, constitute an undertaking on behalf of the INSURED or others to determine or warrant that a JOB SITE, operations,or COVERED LOCATION is legal,safe,or conforms to any applicable standard or requirement, or is in compliance with any environmental law or other law.The Company has the right to interview persons employed by or affiliated with the INSURED,To the extent reasonably practicable,access for the inspection and interviews will be coordinated through the agent or broker of the FIRST NAMED INSURED.The INSURED agrees to provide appropriate personnel and access to its record to assist the Company's representatives during any action taken pursuant to this provision. M. JURISDICTION AND VENUE-In the event that the INSURED and the Company have any dispute concerning, relating to, or a rising out of this Policy,including without limitation its formation,coverage provided hereunder,or the meaning,interpretation or operation of any term,condition,definition or provision of this Policy resulting in litigation or other form of dispute resolution,the INSURED agrees with the Company to submit to the jurisdiction of the state and federal courts in the State of New York,and that any litigation or other form of dispute resolution may take place in the state and federal courts in the State of New York. Nothing in this Condition constitutes or should be understood to constitute a waiver of the Company's right to remove an action to any United States District Court. N. OTHER INSURANCE-This insurance applies in excess of: 1. any applicable Self-Insured Retention or DEDUCTIBLE PERIOD; and 2. the applicable limits of any other valid and collectible insurance available to the INSURED,whether such insurance was issued to the INSURED or another entity,and whether such other insurance is stated to be primary,pro rata,contributory,excess,contingent,or on any other basis,unless such other insurance is specifically written as providing excess Limits of Liability above those provided under this Policy;and 3. with regards to Coverage C,valid and collectible SUBCONTRACTOR'S INSURANCE whether such insurance is stated to be primary,pro rata,contributory,excess,contingent,or on any other basis;and 24 ©2022 SiriusPoint Specialty Insurance Corporation. All Rights Reserved. May not be copied without permission, I 4. with regards to Coverage F,valid and collectible DESIGN ENTITY'S INSURANCE whether such insurance is stated to be primary,pro rata,contributory,excess,contingent,or on any other basis. The Company will only pay its share of any coverage afforded under this Policy that exceeds the total amount of such other insurance. However,solely with regard to an ADDITIONAL INSURED pursuant to SECTION VII.B.2.and Coverages A, I and J, when required by written contract that is signed by the FIRST NAMED INSURED or an ADDITIONAL NAMED INSURED prior to the date the applicable POLLUTION CONDITION or INDOOR CONTAMINANT CONDITION first commences,this insurance applies in excess of any applicable Self-Insured Retention,and primary to,and non- contributory with,any other insurance available to that ADDITIONAL INSURED.The scope and limits of coverage under this Policy will not exceed what is required by the written contract. Upon request of the Company,the INSURED must promptly provide the Company with copies of all such other insurance policies. 0. REPRESENTATIONS-By accepting this Policy,the INSURED agrees that the statements contained in the application and any supplemental materials and other information furnished in connection therewith,or in connection with any amendments to the Policy,are the INSURED's representations,that they are deemed material,that this Policy is issued in reliance upon the truth of such representations,and that this Policy embodies all agreements existing between the INSURED and the Company relating to this insurance. This entire Policy is void if,whether before or after coverage is afforded under this Policy,the INSURED has willfully concealed or misrepresented any fact or circumstance material to the granting of coverage under this Policy,or the terms of or premium for such coverage. As a courtesy to the INSURED,the Company, in its sole discretion,may accept an application that the INSURED completed for another insurance carrier in lieu of completing the Company's application. In that event,the INSURED understands and acknowledges that, by accepting this Policy,the Company has relied upon the INSURED's truth and correctness of such statements, representations and information contained within that application,including any warranty statement,as if made to the Company on the same date. P. SANCTION LIMITATIONS-The Company will not provide any coverage hereunder to the extent that the provision of such coverage would expose the Company to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions,laws or regul ations of the European Union or the United States of America,including but not limited to sanctions,laws and regulations administered and enforced by the U.S.Treasury Department's Office of Foreign Assets Control ("OFAC"). Q. SEPARATION OF INSUREDS-Except with regard to the Limits of Liability,Self-Insured Retention,exclusions or limitations that refer to"any' INSURED,and any rights and duties assigned to the FIRST NAMED INSURED,this Policy applies as if each INSURED were the only INSURED,and separately to each INSURED against whom a CLAIM is made. Except as otherwise provided herein,misrepresentation,concealment,breach of a term or condition,or violation of any duty under this Policy by one(1) INSURED does not,by itself,affect coverage for another INSURED under this Policy. Provided,however,this Condition does not apply to any entity who is a parent,subsidiary,affiliate,director,officer,partner,member or employee of the INSURED that misrepresented,concealed or breached a term or condition,or violated a duty under this Policy. R. SUBCONTRACTOR'S INSURANCE—The FIRST NAMED INSURED or ADDITIONAL NAMED INSURED must not agree to any limitation of liability from a SUBCONTRACTOR with the exception of insurance proceeds without the prior written consent of the Company. 2s ©2022 SiriusPoint Specialty Insurance Corporation. All Rights Reserved. May not be copied without permission. S. SUBROGATION-In the event of payment under this Policy,the Company will be subrogatod to all of the INSURED's rights of recovery.The INSURED must do whatever 1s necessary to secure such rights and must not do anything intentional to prejudice such rights.The Company has priority in any recovery.Any monies recovered as a result of subrogation proceedings accrue first to the Company in excess of the Company's total payment and the casts to the Company of recovery,then to the INSURED, Notwithstanding the foregoing,the Company hereby expressly waives such rights of subrogation against an entity where such rights have been waived, in writing,by the INSURED prior to the applicable CLAIM, POLLUTION CONDITION,INDOOR CONTAMINANT CONDITION,or PROFESSIONAL LOSS. T. TERRITORY-This Policy will only apply to a POLLUTION CONDITION or INDOOR CONTAMINANT CONDITION located,CONTRACTING SERVICES or PROFESSIONAL SERVICES rendered,a CLAIM, POLLUTION PROTECTIVE CLAIM,or DESIGN CLAIM made and at all times solely maintained,and ADA AND FHA EXPENSE,BANKRUPTCY LITIGATION EXPENSE, BUILDING INFORMATION MODELING EXPENSE,DISASTER MANAGEMENT COSTS or SUBPOENA EXPENSE for services performed,within the United States, its territories or possessions, Puerto Rico,or Canada. SECTION VII. DEFINITIONS A. ADA AND FHA EXPENSE means reasonable and necessary fees and expenses incurred by counsel,chosen and retained by the Company,to assist the INSURED with their response to a regulatory or administrative action first brought against the INSURED during the POLICY PERIOD by a government agency under the Americans with Disabilities Act of 1990,42 U.S.C.§ 12101 et. seq.or the Fair Housing Act,42 U.S.C.§ 3601 et.seq.,and alleging an act,error,or omission with respect to the rendering of or failure to render PROFESSIONAL SERVICES on or after the Retroactive Date stated in Item 9.of the Declarations and before the end of the POLICY PERIOD. B. ADDITIONAL INSURED means: 1, any person or entity identified as an ADDITIONAL INSURED in an endorsement attached to this Policy;and 2. solely with regard to Coverage A, I and J,when required by a written contract that is signed by the FIRST NAMED INSURED or an ADDITIONAL NAMED INSURED prior to the date the applicable POLLUTION CONDITION or INDOOR CONTAMINANT CONDITION First commences,ADDITIONAL INSURED also includes: a. the client person or entity for whom the INSURED performs CONTRACTING SERVICES pursuant to such written contract;and b, any other person or entity,unrelated to the FIRST NAMED INSURED or any ADDITIONAL NAMED INSURED pursuant to such written contract; The scope and limits of coverage for such person or entity under this Policy will not exceed what is required by the written contract. Coverage is provided solely for the person's or entity's liability arising out of the FIRST NAMED INSURED's or any ADDITIONAL NAMED INSURED's ownership,maintenance,use,or operation of a COVERED LOCATION, vicarious liability for CONTRACTING SERVICES,or a POLLUTION CONDITION or INDOOR CONTAMINANT CONDITION as applicable.Coverage will only be afforded for such person or entity if that person or entity is named in a lawsuit,petition or regulatory action as a co-defendant with the FIRST NAMED INSURED or any ADDITIONAL NAMED INSURED alleging that it is liable as a result of either the FIRST NAMED INSURED's or any ADDITIONAL NAMED INSURED's ownership, maintenance,use,or operation of a COVERED LOCATION,such person's or entity's vicarious liability for CONTRACTING SERVICES,or a POLLUTION CONDITION or INDOOR 26 O 2022 SiriusPolnt specialty Insurance Corporation. All Rights Reserved, May not he copied without permission.