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Rpr 29 08 09:20a Public Works
<br />04/20/2008 15:44 7149911027
<br />WCA INC
<br />7146473345
<br />p.4
<br />PAGE N ?/04
<br />'IS { an lay 11111 mrmm mn mnr.vm.urw..'.1s......... •ru•- +- ..- _.....�...... ..,..�- ........ _. .-
<br />Certincnte nflnsannee
<br />Itw cnmlWe'r nsnlp lnnmmrcr ofMlbinneononly m4nm.fan nl nplpd llpen the mn9m'. FMJer 1h'e <ullaeFa"'.u,ni'n'MMee Embry Md AaFnM nlNmanivdy or ne4nrvdy nMM, mlmn, .Ir
<br />nlrc.'hr enwry. eR.[skl lg uv NGnie. IIMeJ bcbw f41wy hmin me nn 1111 dM Ilimc hum, nhlgnpF nnliu.. mny'rcludc nddtimd r'4A:oa. ul hM11 bdm.. rnlicy bmF. mn W malad M slmme
<br />a nl' n nsmrnu
<br />This b to WON that (Name Nm Nldman of hnartd)
<br />WEST
<br />MT VI AHURTON B, INC Liberty
<br />1200 LAST VIA 91)ATUN
<br />ANAININ4, CA 91006 Mutual,,
<br />Itmlhr l..'adoi. of llasemlhua mnl".J ly the Camueny ludo n'e pu yrsrl 'med bdmv. n'.IntumMp4 MUe yl'. in[J 1x111 y1klpnaana 11.11d'.irrnnm, MiWlm11"d mndienn, .nJ
<br />el ellcn,1 I, my nm:.msnl, IC'm N..J!4!Lq_^_PI .n11M1 gNr Almmrnr wllh mnlKGl'. whim drm C<mawe mnY lClraaY
<br />W orken Compemntain
<br />Central l,tebtbty
<br />H Claims Madc
<br />X Occumns
<br />Rctru Date
<br />AutamObile Liability
<br />X Owned
<br />X Non-Uwlpd
<br />X Mica
<br />O Oenaul rirbshly polity
<br />M
<br />M
<br />F.
<br />N
<br />T
<br />I04101/20011/041"1112009 I WA2 -10D- 0 394 90 168
<br />the romonba tut.: Bodily Injury By Accident
<br />CA 51,0110,000 Each Accident
<br />Bodily Injury By Direenr
<br />51,000,000 Policy Limit
<br />Bodily Injury By Uhlease
<br />$1,000,000 F.acb Pcryon
<br />0410112008/04lnrQ009 192161 -039490.0IR Gtnerml AggregalbOdler than ProdlCumpkted Operations
<br />*2.000.000
<br />PradreUlCumplelnl Operations Apregatc
<br />S 00R(IOU __
<br />Bodily Injury end Property Damage Liability Per
<br />110(10000 Occurrence _
<br />Perennial and Adveribiree Injury leer Pcrson I
<br />S1,000,000 Or it nmttan_
<br />Other Liability Other Llabi lly
<br />FIRE.. DAMAGES 5100,000 MEDICAL PAYMENTS 15,000
<br />(),110112009/000112(109 AS7 -1rot -09949940 Each Accident - Single Limit - B.1. and P. D. Combined
<br />SI.000A00
<br />Each Person
<br />FAth Accident ar Occurrence
<br />Each Accident or Occurrence
<br />umd iasumt dllrlay OX aohcy lean Addln9arl 1nw1ed. Cloy orSAnln nun, ne olTnnt. cusisk A, rscaM voltiow"s Md reprcXnMJr'es m' Ihc
<br />rol'c 1pvsalcbcd CG201(I 0A4 I@ 1,09219 cadDmcnicny) rhos murancc Is primsy Indnon- conalburnry.
<br />IMraaTANT a nm I.C. m hold., 4 n. AIMITI
<br />SMOOMnON l8 "''MVOD.:nM1'.inl m m¢ J'm' ... 0.
<br />Tie TlMwnd.Nlies emy WIL'mam n Mwrmee hf n
<br />e INn pl. w Il.ftlay let, A .1.1 Vditla —1.
<br />NmrT.111 0.bn fna roplm'nm.uurnunboci
<br />MFeb' uMl nlbwl ln'InomttM•caN enn<MlMlnle
<br />Office ORANGP. CA Pbnne: 714 917 -140n
<br />Certifies. ytoldcr
<br />C: r.y oC 5arl-a And
<br />Public Worka :Agency 2095
<br />220 south Daisy Asm,ise Sualding A
<br />Fan'I:n Ana, CA 92703
<br />rnnnnm A 1. 1- nn an «mno.w mw .In mn•o dim v nu u.n••• - -k •-...,
<br />we mnY,Inm. nn pn4.ramanl. A PNmen.n rho cenl4m'n tlne. ml mnfn rub m me eem4nm F.IYer Nr LLD of nil rn.orwm.nn
<br />h pr.nd I,'A •. rin fin 11 W 03 ssl Ib. ImmA mmma.all[v "'1/ nn he exxAtM en Va am sp Aer•. alludn rMIR.l1'nc mum
<br />Am ream'. m[uvd IIY elm belln"'.ml
<br />;�, ` ,/3
<br />111 SILVIA Vfad
<br />Date tsesled: 04/29/2008 letepared By. IF
<br />Ea iratinn T
<br />Cnntimwus*
<br />Fxvendcd
<br />X
<br />Polity Term
<br />W orken Compemntain
<br />Central l,tebtbty
<br />H Claims Madc
<br />X Occumns
<br />Rctru Date
<br />AutamObile Liability
<br />X Owned
<br />X Non-Uwlpd
<br />X Mica
<br />O Oenaul rirbshly polity
<br />M
<br />M
<br />F.
<br />N
<br />T
<br />I04101/20011/041"1112009 I WA2 -10D- 0 394 90 168
<br />the romonba tut.: Bodily Injury By Accident
<br />CA 51,0110,000 Each Accident
<br />Bodily Injury By Direenr
<br />51,000,000 Policy Limit
<br />Bodily Injury By Uhlease
<br />$1,000,000 F.acb Pcryon
<br />0410112008/04lnrQ009 192161 -039490.0IR Gtnerml AggregalbOdler than ProdlCumpkted Operations
<br />*2.000.000
<br />PradreUlCumplelnl Operations Apregatc
<br />S 00R(IOU __
<br />Bodily Injury end Property Damage Liability Per
<br />110(10000 Occurrence _
<br />Perennial and Adveribiree Injury leer Pcrson I
<br />S1,000,000 Or it nmttan_
<br />Other Liability Other Llabi lly
<br />FIRE.. DAMAGES 5100,000 MEDICAL PAYMENTS 15,000
<br />(),110112009/000112(109 AS7 -1rot -09949940 Each Accident - Single Limit - B.1. and P. D. Combined
<br />SI.000A00
<br />Each Person
<br />FAth Accident ar Occurrence
<br />Each Accident or Occurrence
<br />umd iasumt dllrlay OX aohcy lean Addln9arl 1nw1ed. Cloy orSAnln nun, ne olTnnt. cusisk A, rscaM voltiow"s Md reprcXnMJr'es m' Ihc
<br />rol'c 1pvsalcbcd CG201(I 0A4 I@ 1,09219 cadDmcnicny) rhos murancc Is primsy Indnon- conalburnry.
<br />IMraaTANT a nm I.C. m hold., 4 n. AIMITI
<br />SMOOMnON l8 "''MVOD.:nM1'.inl m m¢ J'm' ... 0.
<br />Tie TlMwnd.Nlies emy WIL'mam n Mwrmee hf n
<br />e INn pl. w Il.ftlay let, A .1.1 Vditla —1.
<br />NmrT.111 0.bn fna roplm'nm.uurnunboci
<br />MFeb' uMl nlbwl ln'InomttM•caN enn<MlMlnle
<br />Office ORANGP. CA Pbnne: 714 917 -140n
<br />Certifies. ytoldcr
<br />C: r.y oC 5arl-a And
<br />Public Worka :Agency 2095
<br />220 south Daisy Asm,ise Sualding A
<br />Fan'I:n Ana, CA 92703
<br />rnnnnm A 1. 1- nn an «mno.w mw .In mn•o dim v nu u.n••• - -k •-...,
<br />we mnY,Inm. nn pn4.ramanl. A PNmen.n rho cenl4m'n tlne. ml mnfn rub m me eem4nm F.IYer Nr LLD of nil rn.orwm.nn
<br />h pr.nd I,'A •. rin fin 11 W 03 ssl Ib. ImmA mmma.all[v "'1/ nn he exxAtM en Va am sp Aer•. alludn rMIR.l1'nc mum
<br />Am ream'. m[uvd IIY elm belln"'.ml
<br />;�, ` ,/3
<br />111 SILVIA Vfad
<br />Date tsesled: 04/29/2008 letepared By. IF
<br />
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