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QD <br />.�C�%2© <br />C" CERTIFICATE 4E LIABILITY INSURANCE <br />DATE tMM/DD/YYYY) <br />12127/2016 <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(ies) 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 />pp / <br />Hall Company <br />& C <br />A/E Insurance Services <br />1966010th Ave NE <br />CONTACT <br />NAME: Llnnea Svensson,. License OK.02022 <br />_ <br />PFIFAX <br />C}NE E.r). 360-626-2023 Na). 360-598-3703 <br />E-MAIL . Isvensson@hallandcompany.com <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />Poulsbo, WA 98370 <br />INSURER A: LibertyInsurance Underwriters Inc <br />19917 <br />9/201201',6 <br />INSURED 1 279 <br />INSURER B :Traveler's Property CasuMty Company <br />25674 <br />Century Structural Engineering CO Inc <br />24719 Narbonne Avenue <br />INSURER C: <br />Lomita CA 90717 <br />INSURER D <br />E.: <br />rINSURER <br />INSURER F: <br />MED EXP (Any ane Person) ''...... $5,000 ........ <br />COVERAGES CERTIFICATE NUMBER! 137309184 REVISIONNUMBER- <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 />INTRR TYPE <br />_POLICY <br />OF INSURANCE <br />AIN ID <br />WVD <br />POLICY NUMBER <br />EFF <br />MMIDDNYYY' <br />POLICY EXP <br />MMIDDMYYY <br />..... <br />LIMITS <br />B <br />X <br />COMMERCIAL GENERAL LIABILITY <br />6802H676069 <br />9/201201',6 <br />912012017 <br />EACH OCCURRENCE $1,000,000 <br />CLAIMS -MADE OCCUR <br />..5AMAGE TO.. RENTED -__......_. <br />PREMISES Ea occurrence .._$1,000,000 <br />MED EXP (Any ane Person) ''...... $5,000 ........ <br />PERSONAL SADV IINJURY $1,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $2,000,000 <br />POLICY PERT ❑ LOC <br />PRODUCTS - COMP/OP AGO $2,000,000 <br />...._....$ <br />OTHER: <br />B <br />AUTOMOBILE LIABILITY <br />6802H676069 <br />9/2012016 <br />9/20/2017 <br />COMEa accdoni N LIMIT $1„000,000 <br />BODILY INJURY (Per person) $ <br />ANY AUTO <br />ALL UUTOWNED AUUTOSULED <br />BODILY INJURY (Per accident) $ <br />NON -OWNED <br />HIRED AUTOS X AUTOS <br />PRlJPEFITY 15AMIA9E ... <br />Per accident $ <br />UMBRELLA LAB OCCUR <br />i..... <br />EACH OCCURRENCE $.... <br />AGGREGATE $ ....-..__ <br />EXCESS LAB CLAIMS -MADE <br />$ <br />DED RETENTION$ <br />I <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y 1 N <br />PER. OTH- <br />STATUTE ER <br />ANY PROPMETOPJPA.RTNEiRA•EXECUTIVE <br />E.L. EACH ACCIDENT $ <br />OFFICERWEMBER EXCLUDED' ElN <br />/ A <br />E.L. DISEASE - EA EMPLOYE 1 $ <br />(Mandatary In Nit) <br />If yes, describe under <br />--._... <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ <br />A <br />Professional LIab;Claims Made <br />AEX2004830116 <br />7/24/2016 <br />7124/2017 <br />$1,000,000 Per Claire <br />$1,000,000 Aggregate <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached if more space is required) <br />The certificate holder is an additional insured per the attached. <br />P,P,Vtew r � <br />CERTIFICATE HOLDER CANCELLATION <br />a 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE, DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana Planning And Building Agency <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />PO Box 1988 (Ali -19) <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92742-1988 <br />AUTHORIZED REPRESENTATIVE <br />kwa- %etx. <br />a 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />