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DATE (MM/ODM'YY) <br />- �'►►co�zo" CERTIFICATE OF LIABILITY INSURANCE <br />��- oansno�� <br />THIS CERTIFICATE IS ISSUED AS 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 />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(las) must be endoreed. If SUBROGATION IS WAIVED, subject to <br />the terms and condHlons of the policy, certain policies may require an endoreemant. A statement on this certificate does not confer rights to the <br />cer8flcate holder in Ilea of such endoreamant(s). <br />PRODUCER phone: (380) 598 -3700 Fax: (360) 598 -3703 HnmepcT MICHAEL J. HALL 8 COMPANY <br />MICHAEL J. HALL &COMPANY -PHONe - - -- - - _ _ cAx - - - -- <br />tac No �,g: (360) 598 3700_ _.__. __ ____ __ _�(,,,ac H� (360) 598 -3703 <br />A/E INSURANCE SERVICES E -Lwli - - - _ -- - - - -__ -- - � -� - -�- -' <br />79660 10TH AVENUE N.E. ADDRESS:_. _ _ __. _ <br />PRODUCER 1273 <br />POULSBO WA 98370 cusTOmgg iD __. _. _ _ ____ _ <br />Agency Lic#: 0792445 INSURERS) AFFORDING COVERAGE NAICM <br />INSURED INSURERA L10yd�B Of LOndOn <br />Century Structural Engineering Co Inc <br />24719 Narbonne Avenue INSURER a Travelers Property Casualty Company of America 25674 <br />Lomita, CA 907'17 -� 623 INSURER D <br />I I INSURER F I I <br />COVERAGES CERTIFICATE NUMBER: '135630 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 REOUIREME NT, 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADD'L <br />INSR <br />suBR <br />1M!D_ <br />POLICY NUMBER <br />POLICY EFF <br />MM/DOIYWY <br />POLICY E%P <br />(MM/DWWYY)__ <br />LIMITS <br />_ __ _ __ ______ ___ <br />EACH OCCURRENCE <br />DAMAGE To RENTED <br />PREMISESfEe acamj__ _ <br />$ <br />B <br />_ _ _, <br />GENERAL uABIUTY <br />X COMMERCIAL GENERAL LIABILITY <br />___ _ <br />CLAIMS -MADE X 1 OCCUR <br />X XCU / BFPD/ OCP <br />_.___ ___ <br />6804863L938 <br />_ <br />09/20/70 <br />09/20M'1 <br />$ '1,000,000 <br />$ 300,000 <br />_________ _ <br />MED. EXP (Any one person) <br />g 6,000 <br />$ 7,000,000 <br />PERSONAL 8 ADV INJURY <br />GENERAL AGGREGATE <br />PRODUCTS - COMP /OP AGG <br />X Seperetion o! Insuretls <br />GEN'L AGGREGATE LIMIT APPLIE_5 PER: <br />_.__� or.� �.-.. Y 1 PRO_ � �I nr. <br />g 2,000,000 <br />$ 2,000,000 <br />- -_ _. _ - _ _ <br />c __ _- _- - __'- __ <br />-_ y- ..__.__.�-- ._ +....�...�__�___� _— _ _ _ __- -- ____._.___.___..__.___ -__ - ..__._ -___ - -_ _ _ _ . <br />AuioMOBILE wB1ulY 6804863L938 09/20/'10 09/20M'1 COMBINED SINGLE LIMIT $ '1,000,000 <br />(Ea aocltlenq <br />-�- BODILY INJURY (Per person) $ <br />ALL OVIRJED AVTOS - - -__ -�- -' - -�- <br />- BODILY INJURY (Per aeeitlenQ $ <br />_ SCHEDULED AUTOS <br />PROPERTY DAMAGE $ <br />X HIRED AUTOS (Par acotlent) <br />X NON- OWIJED AUTOS �VZL•� 1� � __ ___ $ __ _ <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Ci of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />tY ACCORDANCE WITH THE POLICY PROVISIONS. <br />Planning And Buflding Agency <br />PO Box 1988 (M -20) gUTHORIZEO REPRESENTATIVE <br />Santa Ana, CA 92702 -1988 <br />Attention: Ms_ Tonle Zerba <br />Matt ew L. `opus <br />Thu Af`nRn ,eamu sort Inns nru ranictara•ri ma <br />uaBRELU Lua OCCUR <br />/ <br />EACH OCCURRENCE <br />$ <br />_- _______ -- - .__._..__ -.__ <br />AGGREGATE <br />y - <br />ExcESS Lw0 CLAIMS -MADE <br />_ <br />DEDUCTIBLE <br />j// <br />� 1 <br />_ _ _ <br />$ <br />Q Cj <br />RETENTION $ <br />RY Qe <br />S <br />VVORKER9 COMPENSATION <br />y <br />CIi <br />A �r <br />OT RYTLIMITS OpR <br />$____ ._. <br />AND EMPLOYERS' LUBILITY y / N <br />pNY PROPRIETOR/PARTNER/E%ECUTIVE <br />E.L EACH ACCIDENT <br />$ <br />__ <br />E.L. DISEASE EMPLOYEE <br />-- - <br />$ <br />OFFICER/MEMBER E %CLUDEO] � <br />- <br />N/p <br />IM.,.a�aoy x, NM — <br />_EA. <br />_, _ _ <br />$ <br />1! yee, describe antler <br />DESCRIPTION OF OPERAnoNS below <br />07/24M0 <br />07/24/'17 <br />E.L. DISEASE - POLICY LIMIT <br />A <br />uProfessional Uability Claims MetlaFOrtn <br />HPP7684 /0'10 <br />S� 000,000 Per Claim <br />ACORD t01, At101tlonal Remarks Schedule, <br />Is required) <br />§1,000,OOOAggregate <br />DESCRIPTON <br />OF OPERATONS / LOCATIONS /VEHICLES <br />(Attach <br />h more space <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Ci of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />tY ACCORDANCE WITH THE POLICY PROVISIONS. <br />Planning And Buflding Agency <br />PO Box 1988 (M -20) gUTHORIZEO REPRESENTATIVE <br />Santa Ana, CA 92702 -1988 <br />Attention: Ms_ Tonle Zerba <br />Matt ew L. `opus <br />Thu Af`nRn ,eamu sort Inns nru ranictara•ri ma <br />