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DATE {MMIDDVYYYY) <br />' �-+�' �' CERTIFICATE OF LIABILITY INSURANCE <br />08111!2011 <br />THIS CERTIFICATE IS ISSUED A3 A 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 />?:-'3 REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poliCy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject LO <br />the terms and condWOna o/ the policy, certain polidas may require an endorsement. A statement on this certificate does not conter nghts to the <br />certificate holder In lieu of sucA endorsamenl(s)_ <br />PRDOUGER Phorre: (36D) 598 -3700 Fax (360) 598 -3703 coNrncT MICHAEL J. HALL 8 COMPANY <br />NAME: <br />MICHAEL J- HALL S COMPANY PHOHe " "" _ " " "" " " " "" "- - fwx - -- <br />' A!E INSURANCE SERVICES IA/c._Nn. F� (360) 598 -3700 _ _ I� �), _ (360) 598 -37D3 <br />�' E -MAIL � _ <br />' 19660 10TH AVENUE N.E. ^o��. ....... - - -_ _._ ___. ____. ___. .._. ____._.._. <br />.. POULSBO WA 98370 PRDDUCEIi 1273 _. _..__ ____. __. __ ..._... <br />CUSTQMER I¢ <br />",. ",. ", AOency L�cC OT92445 INSURERS) AFFORDING COVERAGE NAIC it <br />INSLflED _ __.. ......... _....... ____ ___._ ...... _ _. _.. __._ ____ _ _. _._.. <br />Century Structural Engineering Co Inc INSURER A - Lloyd's Of London <br />24719 Narbonne Avenue WSURER B Travelers Property Casualty Company of America 25674 <br />Lomita, CA 90717 -1523 iNSUaER c <br />INSURER E <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER= 143028 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 ANV 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 IS SUBJECT TO ALL THE TERMS, <br />INSR TYPE OF INSURANCE ADD'L SUER POLICY EFF � POLICY EIrP <br />LTg..i ........ _. .. _ .INSR WVDI ____. POLICY NUMBER .. IMWV4N.YWY7 t_. IMM/DD/YYYYI _. __ LIMfT3 <br />B QENEAAL LIABILITY � _ - <br />i a 6804853L938 09/26/10 ( 09/26/11 � EACH OCCURRENCE $ 1.000.600 <br />X GOMMERC WL GENERAL LIABILITY � � DAMAGE r0 pENTEO " ' ,j 360,000 <br />� � CLAIMS -MADE X '; OCCUR � � � MED EXP (Any Dire person) g 5,666 <br />X XCU / BFPb/ OCP � ...__ ,. _ <br />I PERSONAL 8 ADV INJURY i 1,666,666 <br />1 X 5operation or Insureds '., � GENERAI. AGGREGATE I S 2,606,606 <br />GEN L AGGREGATE LIMIT APPLIES PER. <br />'; g 2,000,000 <br />__. _ _ <br />1 <br />POUGY ( X LOC <br />i $ <br />_�_. ECT <br />_ _ _ _ _ ....._. <br />� <br />B AUTOMOBILE LWHILnY <br />I <br />6eoas53L9ae � o9izwlo 09l2olti <br />ANY AVTO � <br />�'. <br />',,.. <br />ALL OWNED AUTOS '. <br />'. <br />'. SCHEDULED AUTOS ', <br />', <br />X HIRED AUTOS <br />X <br />s- <br />OVEN A.� TO FORM <br />hON -OWNED AUTOS ', ',. <br />i <br />UMBRELLA LM.B OCCUR <br />� - <br />E><CEaS LIAR__.. CLAIMS -MADE I I <br />y � � (� ` <br />beD�cnBLE <br />EY O. E <br />RETENTION S _. <br />_ .. ar1(1 <br />-CIi - A�i�Ki' - - -- - <br />WORKERS COMIPENBATON <br />I $ _ _ <br />AND EMPLOYERS' LIAa1LITY Y/N <br />-'.. <br />{ <br />ANY PROPRIETORIPARTNERIEJ[ECUTNE I "'" <br />g <br />�I OFFICERINEMBER E%ttUDEDi � N/A � '.. <br />''.. <br />I <br />iManeatory In NHi <br />y <br />v yea. aearfeo �,wer <br />DE£aCRIPT1pN OF OPERATONS Eelwv <br />- <br />- <br />A._.. Proressaonai ueblllty Claims Made Form <br />HPP1584/011 07124/11 � 07!24112 <br />DESCRIPTION. OF OPERATIONS / LOCATION31 VEHICLES (Attach ACORO 101, Additlonal Remarks 3chadvle, If more apace b required) <br />City of Santa Ana <br />Planning And Building Agency <br />PO Box 1988 (M -19) <br />Santa Ana, CA 92702 -1988 <br />Attention: <br />PRODUCTS - COMP /OP AGG <br />__ __ <br />'; g 2,000,000 <br />__. _ _ <br />i $ <br />COMBINED SINGLE LIMIT <br />i� 6 1,600,000 <br />(Ea accident) <br />BODILY INJURY (Per person) <br />'., $ <br />BODILY INJURY (Par eCDldenl) <br />I, $ <br />:: <br />PROPERTY DAMAGE <br />(Per acddenq _ <br />, _.., ..... <br />:s <br />_ _ <br />s <br />EACH OCCURRENCE <br />�$ __ __ <br />AGGREGATE <br />{g <br />a <br />;$ <br />WC STwTU- .... <br />I $ _ _ <br />e TOi#Y LIMITS �... ER <br />.._ .. <br />E. L. EACH ACCIDENT <br />g <br />E.L. DISEASE -EA EMPLOYEE <br />g <br />E.L DISEASE - POLICY LIMIT <br />y <br />.... <br />51,000,000 Par Claim <br />51.000,000 Aggregate <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS_ <br />AUTHORIZED REPRESENTATIVE _ _... _. <br />The ACORD name and logo are registered <br />