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<br />~f91ttf:T <br /> <br />PRODUCER Ronald Pue <br />Hub International of California In <br />4371 Latham Street Suite 101 <br />PO Box 5345 <br />Riverside, CA 92501 <br />951 788 8500 951-788-2994 <br />INSURED <br />11M Incorporated <br />12891 Nelson st. <br /> <br /> <br />DATE {MMlDDIYV] '~k: <br />6/27/2007 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. <br />COMPANIES AFFORDING COVERAGE <br />~~~ scottsdale Insurance Company <br />A <br />~PAAW American states Insurance company <br />B <br /> <br />COMPANY <br />C <br /> <br />Garden Grove CA 92840-5018 <br /> <br />~PAAW <br />D <br /> <br /> <br />~ ~ <br />TH1S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED N!O\IE 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, TtE INSURANCE AFFORDED BY TtE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH F'OUCIES. UMJTS SHOWN MAY HAVE BEEN REOLICED BY PAID CLAIMS. <br /> <br />eo <br />'TR <br /> <br />TYPE OF INSURANCE; <br /> <br />POLICY NUMBER <br /> <br />POLIC'l' EFfECTIVE POUCY ElCPIRAi10N <br />DATE(NMIDDN'Y] DAT&: (MMIDM'Y) <br />06/27/2007 06/27/2008 <br /> <br />u.". <br /> <br />A G........"IABIU!Y BCS0015293 <br />X COMMERCIAL GENERAl. UABlUTY <br />CLAIMS MAtE 00 QCO..JR <br />OWNER'S & CONTRACTOR'S PROT <br /> <br />GENERAL AGGREG"TE <br />PRODUCTS. COMPfOP AGG <br />PERSONAL. & ADV INJtJRY <br />EACH OCOJRRENCE <br />FIRE DAMAGE (Any one lint) <br />MED EXP (Anyone person <br /> <br />. 2 000 000 <br />. 2 000 000 <br />. 1 000 000 <br />. 1 000 000 <br />. 100 000 <br />. excluded <br /> <br />. 1,000,000 <br /> <br />B AUTOMOBILE LlAB1UT'f <br /> X AN'( AUTO <br /> AlL OWNED AUTOS <br /> SCHEDUlED AUTOS <br /> X HIRED AUlOS <br /> X NQN..OWNED AUTOS <br /> <br />01CH 159159-2 <br /> <br />06/03/2007 6/03/2008 <br /> <br />COMBINED SINGLE UMrr <br /> <br />THE PROPRIETOR! <br />PARTNERSIEXECUTIVE <br />OFFICERS ARE: <br />OTHER <br /> <br />INCl <br />EXe, <br /> <br /> <br />G f? <br /> <br />,,,,,,,..,,.Z:-ttur"j,::' <br /> <br /> BODIL.Y INJURY . <br /> tperpeltiOn) <br /> eODILY INJURY . <br /> (paraccklent) <br /> PROPERTY DAMAGE . <br /> AUTO ONL.Y - EA ACCIDENT . <br /> OTHER THAN AUTO ONLY: <br /> EACH ACCIDENT . <br /> AGGREGATE . <br /> EACH OCCURRENCE . <br />, AGGREGATE . <br /> . <br /> WCSTAl\J. 01H- <br /> EL EACH ACClOENT . <br /> EL DISEASE. POLlCY LIMIT . <br /> EL DISEASE. EA EMPLOYEE . <br /> <br />GARAGE LIABIUTY <br />ANY AUTO <br /> <br />EXCESS UABJUTY <br /> <br />UMBRELLA FORM <br /> <br />OTHER THAN UMBREU.A FORM <br /> <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABIL.1TY <br /> <br />;\:.~".?~(' \r;~') '\," <br /> <br />DESCRIPTION OF OPEftl.TIONSJLOCATIOtISNCHICLCSI$PECIAL ITEMS <br />Santa Ana Park~ng Structure - Job 12515 <br />GWGC, Inc. dba: Go=don and Williams ~-neral Contractors and the City of Santa Ana, its officers, directors, agents, volunteer <br />and representatives are an additional insured per form: CG20330704, OG20370704, & UTS-3g-01 (3-92). <br />primary wording included in UTS-3g-01 (3-92). Attached Waiver of SUbrogation endorsement i CG 2404(10/93) applies. <br />tt ' ~ ct eneral ao reaate en e ~ 7 . <br /> <br /> <br />The City of Santa Ana <br />20 Civic Center Plaza 8th floor <br />Santa Ana, CA 92701-4058 <br /> <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIE5 81! CANCELI.5D SliFOR! THE <br />EXPIRATION DATE THSI:EOF. THE lSSUlNG CQMPAKY WIll liNDEAVOR TO MAIL <br />1 0 DAYS ~lTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THli LEFT, <br />!'i:l""oays notl.ce for non-payment <br />BUT FAJLURE TO MAIL SUCH NO~ SHALl. IMPOaE NO OBLIGATION OR UAB1UTY <br />OF AMY KIND UPON THE COMPANY, ITS REPRESSiTATIVES. <br />AUlllORI2EQ REPRESENTATNE <br /> <br /> <br />:.... L~:'~+;W~"7t:~$%#~~ <br /> <br /> <br />~w... <br />',~v <br /> <br /> <br />~dslt2948324 <br /> <br />149342 <br />