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A6CWn® CERTIFICATE OF LIABILITY INSURANCE <br />OATS (MMIODA YV) <br />3/16/2016 <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 <br />Michael J Hall & CompanyPHONE30_ <br />A/E Insurance Services <br />19660 10th Ave NE <br />NAME:CT Michael J Hall & Company. L' <br />FAX <br />- A/C Ne: <br />A DRESS: 'Ile.ates@hallandcompany.com <br />INSURERS AFFORDING COVERAGE NAIC# <br />INSURER A:The T avelem lodemnity <br />68048531938 <br />INSURED 1273 <br />INSURER 8:1-lberly Insurance Underwr terS 10Q1 19917 <br />INSURER C: <br />Century Structural Engineering Cc Inc <br />24719 Narbonne Avenue <br />Lomita CA 90717 <br />INSURER D <br />INSURER E: <br />INSURER F : <br />DPREMISESS AMAGE(RELATE <br />Ea occurrence) $390,000 <br />COVERAGES CERTIFICATE NUMBER: 1677758463 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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />rypE OF INSURANCE <br />ADDLSUBR <br />INSR <br />MID <br />POLICYNUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMDDIYYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />68048531938 <br />9/20/2015 <br />9/20/2016 <br />EACH OCCURRENCE $1,000,000 <br />XCOMMERCIAL GENERAL LIABILITY <br />DPREMISESS AMAGE(RELATE <br />Ea occurrence) $390,000 <br />MED EXP (Any one person) $5,000 <br />CLAIMS -MADE � OCCUR <br />PERSONAL &ADV INJURY $1,000,000 <br />X OCP/XCU/BFPD <br />X <br />Separation lrlsds <br />GENERAL AGGREGATE $2,000,000 <br />GEHL AGGREGATE <br />LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGO $2,000,000 <br />POLICY <br />X I PRO- Ll LOC <br />JECTA <br />$ <br />AUTOMOBILE LIABILITY <br />6804853L938 <br />9/20/2015 <br />9/20/2016 <br />UUMBINILD SINN <br />Ea accident) 1,000,000 <br />BODILY INJURY (Per person) $ <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY Per accident $ <br />( ) <br />X HIRED AUTOS X NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE $ <br />Per accident <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />WC STATU- OTH- <br />ANDEMPLOVERS'LIABILITY YIN <br />T YL IT <br />E. L. EACH ACCIDENT $ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE❑ <br />CFFICE WMEMBER EXCLUDED? <br />NIA <br />E.L. DISEASE - EA EMPLOYE $ <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT $ <br />B <br />Professional LIab;Clalms Made <br />AEE200483 <br />7/24/2015 <br />7/24/2016 <br />$1,000,000 Per Claim <br />$1,000,000 Aggregate <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is rectul red) <br />Certificate Holder(s) is/are an Additional Insured on the Commercial General Liability and Auto Liability when required by written contract or <br />agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability insurance is primary insurance and <br />any other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance. Ayyai er of <br />subrogation applies to the Commercial General Liability, and Auto Liability in favor of the Additional Insured. <br />a rrmjv 9-0 <br />If <br />A - ® _ ac) <br />CERTIFICATE HOLDER CANCELLATION <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana Planning And Building Agency <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />PO Box 1988 (M-19) <br />Santa Ana CA 92702-1988 <br />AffU,,I(1T��H__ORIIZ--ED REPRESENTATIVE <br />/J.JrX7G4 �- <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />