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CERTIFICATE OF LIABILITY INSURANCE <br />OA7E (MMIDO/YYYY) <br />09/12/2011 <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 policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsement(s). <br />PRODUCER Pion; .(360) 598-3700 Fax (360) 598-3703 <br />COHTAC7 MICHAEL J. HALL & COMPANY <br />MICHAEL J. HALL & COMPANY <br />A/E INSURANCE SERVICES <br />PHONE — FAx -- <br />,No.N g (360) 598-3700 —i(aO Hol., (360) 598-3703 <br />1966010TH AVENUE N.E. <br />POULSBO WA 98370 <br />– - <br />PRODUCER 1273 <br />QUSTOMER ID, <br />INSURER(S) AFFORDING COVERAGE NAIC III <br />Agency Lick 0792445 <br />_ <br />INSURED <br />Century Structural Engineering Co Inc <br />24719 Narbonne Avenue <br />Llo d's Of London <br />INSURER : Y <br />INSURER e : Travelers Property Casualty Company of America 25674 <br />8 <br />INSVRERC <br />Lomita, CA 90717-1523 <br />INSURER D: <br />INSURERE <br />DAMAGE TO RENTED <br />PREMISES r a) S 300,000. <br />INSURERF <br />PERSONAL & ADV INJURY g 1,000,000 <br />COVERAGES CERTIFICATE NUMBER; 145128 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 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 />ONDIJQNSOFSL1CHP�LICIES.LI LISSHOWN HAVE BEEN RE UGED BY PAID CLAIMS, <br />MSR <br />LT <br />TYPEOFINSURAHCE <br />_.. <br />ADOI- <br />R <br />SUSS <br />1, <br />POLICY NUMBER <br />POLiCYEFF <br />I L. <br />PoUCYEXP <br />_lkl <br />LIMITS <br />B <br />GENERAL LIABILITY <br />68048531-938 <br />09/20111 <br />09/20112 <br />EACHOCCURRENCE S 1,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMSMADE I7 OCCUR <br />DAMAGE TO RENTED <br />PREMISES r a) S 300,000. <br />MED. EXP (Anyone person) s 5,000 <br />PERSONAL & ADV INJURY g 1,000,000 <br />X XCU / BFPD/ OCP <br />X Separation Gf Insureds <br />1 <br />GENERAL AGGREGATE S 2,000,000 <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OPAGG S 2,000,000 <br />X I' LOC <br />POLICY JEQT <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />68048531_938 <br />09120111 <br />09/20/12 <br />i COMBINED SINGLE LIMIT $ 1,000,000. <br />ANY AUTO <br />BODILY INJURY (Per person) $ <br />ALL OWNED AUTOS <br />BODILY INJURY (Per accident) s <br />X <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />TO FM <br />PROPERTY DAMAGE <br />(Per accident) 5 <br />$ <br />X <br />NON-0WNEDAl1TOS <br />S <br />uMSRELu LNAe <br />OCCUR <br />I <br />` <br />1 <br />j+ <br />EACH OCCURRENCE $ <br />AGGREGATE g <br />ExcEss Nue <br />CLAS -ME <br />IM AD <br />� ' <br />y <br />f <br />DEDUCTIBLE _ <br />$ <br />5 <br />RETENTION 5 <br />WORKERS COMPENSATION <br />W OT"S <br />TORY LIMIT <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNENExECUTIVE ❑ <br />OFFIGfRIMEMBER EXCLUDED? <br />(Manddury In NN) <br />NIA <br />E.L. EACH ACCIDENT 5 <br />E. L. DISEASE -FA EMPLOYEE S <br />E.L DISEASE -POLICY LIMIT S <br />I, y... describe under <br />DESCRIPTION OF OPERATIONS Mm <br />A <br />Professional UabilityClaimsMaGe Form <br />HPP15841011 <br />07124/11 <br />07124/12 <br />$1,000,000 Per Claim <br />$1,000,000 Aggregate <br />DESCRIPTION OF OPE RATIO NS I LOCA71ONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <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 />City ACCORDANCE WITH THE POLICY PROVISIONS. <br />Planning And Building Agency <br />PO Box 1988 (M•19) AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702.1988 <br />Attention: it –10AC'o <br />essic3rpe / <br />ORD 25 ( 09 09) c 2009 ACORD CORPORAION, AIT rights reserve . <br />The ACORD name and loco are registered marks of ACORD <br />