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A~ <br />~ <br />~~~ <br />~~~~ <br />~ ~ <br />~ <br />~ :~ DATE IMMIODIYYI '. <br />~ <br />~~ <br />~~~ <br />~/• •t/TM :: <br />i <br />^ <br />~ <br />i~~' <br />. ...... :...: f. <br />~ <br />iii <br />.. ...:. ~[ <br />i,/ <br />'iX f. <br />:':05/19/2007 <br />PRODUCFA Ronald Pue THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Hub International of California In ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />4371 Latham Street Suite 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />PO Box 5345 COMPANIES AFFORDING COVERAGE <br />Riverside, CA 92501 COMPANY Mt Hawley Insurance Company <br />951-788-8500 951-788-2994 '4 <br />INGURED COMPANY American States Insurance Company <br />HBA Incorporated B <br />12891 Nelson St. <br /> COMPANY <br /> C <br />Garden Grove CA 92840-5016 <br /> COMPANY <br /> D <br />CL1CffAAIG~ <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />CO TYPE Of INSURANCE POLICY NUMBEA POLICY EFFECTIVE PODCY IXPIRATION LIMITS <br />LTR GATE IMM/DDPTV) GATE IMMlDDlYYI <br />A GEN ERAL LIABILITY MGL0147390 06/27/2006 06/27/2007 GENERAL AGGREGATE 8 2, OOO, OOO <br /> X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG 9 1, OOO, 000 <br /> <br /> CLAIMS MADE ~X OCCUR PERSONAL a ADV INJURY 8 1 r OOO , OOO <br /> OWNEfl'S hCONTRACTOfl'S PROT EACH OCCURRENCE S 1r OO0, 000 <br /> FIRE DAMAGE (Any ona fuel g SO , OO0 <br /> MED E%P (Any one person! e$ r 0 0 0 <br />B .wr oMOBILE LIABIUrY O1CH-159159-2 06/03/2007 06/03/2008 <br /> X COMBINED SINGLE LIMIT 41r OOO, 000 <br /> ANV AUTO <br /> ALL OWNED AUTOS <br />SODILV INJURY <br />S <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS <br />BODILY INJURY <br />S <br /> NON-OWNED AUTOS (Per accitlentl <br /> <br /> PROPERTY DAMAGE S <br /> GARAGE LIABNTY AUTO ONLY-EA ACCIDENT 9 <br /> ANY AUTO OTHER THAN AUTO ONLY: <br /> EACH ACCIDENT 9 <br /> AGGREGATE 8 <br /> E%CESS DABIUTY EACH OCCURRENCE 4 <br /> UMBRELLA FORM AGGREGATE 9 <br /> OTHER THAN UMBRELLA FORM g <br /> WORKERS COMPENSATION ANO WC STATU- 0TH- <br />R <br />' <br />;' <br /> EMPLOYERS' LIABIIITY <br /> EL EACH ACCIDENT 9 <br /> THE PROPRIETOR/ <br />EXECUTIVE <br />PTNE <br />S INCL EL DISEAGE-POLICY LIMB 8 <br /> PA <br />R <br />/ <br /> OFFICERS ARE: E%CL EL DISEASE-EA EMPLOYEE S <br /> OTHEP <br /> 3T. <br />DESCRIPTION OF OPEIIATIONSILOCATONS!VEHICLES/SPECIA ITEMS <br />Santa Ana Parking Structure - Job 82515 <br />GWGC, Inc. dba: Gordon and Williams General Contrac[oraand the City of Santa Ana, its officers, directors, agents, volunteer <br />and representatives are an additional insured per form: CGL 216"(09/9&), includes primary wording. <br />Waiver of Subrogation: CG 2404(10/931 <br />Per Io'ect a re ate farm: CG2503 03 99 <br />CERTIFECATEH04UER ~.`. .. ~.:; ~> .-,:: . CANG€€.i:A"Fl6N:~ ~ ~: <br />The Ci Cy O£ Santa And SHOULD ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLED BEFORETHE <br />20 C1V1C Center PldZd 8th FlOOr EXPIRATION GATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL <br />Sdntd And, CA 92701-4058 3 O DDAYS WRITTEN NOTICE TO <br />CENTIFICATE MOLDER NAMED TO THE LEFT. <br />T <br />HE <br /> p <br />y <br />m <br />TION O <br />BrUT FAILU <br />E TO <br />S <br />C <br />T <br />LI <br />Y <br />APPROVED S TO R <br />MAIL <br />U <br />H NO <br />ICE BNALL IMPOSE NO OBLIGA <br />R LIABI <br />T <br />FORM <br /> OF ANV KING UPON THE COMPANY. RS AGENTS OR REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE r <br />/__ <br />Ap <br />y <br /> ` <br />/ <br />/ <br />/ <br />! ~, r <br />A&ORD;25 9 €'f(fi5l~ sI ~IAQQRQ Cfft#p0 iG11Y t9tf8 <br />and°"'Q16A'ft ' °' hief ABSIBtant City Attflrn®y <br />