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HomeMy WebLinkAbout2146 CORTE MORAL; ; CB060789; Permit05-02-2006 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Pool Permit Permit No CB060789 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # Project Title 2146 CORTE MORAL CBAD POOL 2552610100 Lot# 0 $26,600 00 Construction Type NEW CARLOS RES - 700 SF POOL/SPA Status ISSUED Applied 03/20/2006 JMA 03/27/2006 03/27/2006 Entered By Plan Approved Issued Inspect Area JM Applicant AZURE POOL CONSTRUCTION CO 7423 EL CAJON BLVD LA MESA CA 91941 Owner CARLOS C ANTHONY&SHARON E 2146 CORTE MORAL CARLSBAD CA 92009 Building Permit Add'l Building Permit Fee Plan Check Add'l Plan Check Fee Electrical Fee Plumbing Fee Strong Motion Fee Renewal Fee Add'l Renewal Fee Other Building Fee Additional Fees $226 31 $000 $14710 $000 $2000 $2700 $266 $000 $000 $6000 $000 TOTAL PERMIT FEES $483 07 Total Fees $483 07 Total Payments To Date $483 07 Balance Due $000 BUILDING PLANS IN STORAGE -ATTACHED Inspector FINAL A Date _t Clearance NOTICE Please take NOTICE thai approval of your project includes the "Imposition" of fees dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions " You have 90 days from the date this permit was issued to protest imposition of these fees/exactions If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3 32 030 Failure to timely follow that procedure will bar any subsequent legal action to attack review, set aside, void, or annul their imposition You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning zoning grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has oreviouslv otherwise expired 03-27-2006 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Right of Way Permit Permit No RW060114 Job Address Permit Type Parcel No Start Date Insurance Expire Liability Insurance Reference* Location Project Title Description 2146 CORTE MORAL CBAD ROW Subtype MINOR 2552610100 Lot* 0 Est Complete Date 10/01/2006 Traffic Control Plan Y Y GOP CARLOS RESIDENCE POOL & SPA Status ISSUED Applied 03/22/2006 Issued 03/27/2006 Expired 09/01/2006 Entered By TNKB Applicant AZURE POOL CONSTRUCTION CO 7423 EL CAJON BLVD LA MESA CA 91941 Total Fees $290 00 Total Payments To Date $290 00 Balance Due $000 Permit Fee Additional Permit Fee Other Additional Fees TOTAL PERMIT FEES $290 00 $000 $000 $000 $290 00 This permit may be revoked by the City Engineer if it is deemed that inadequate progress is being made towards the completion of the work or if the work does not meet City Standards The applicant may be billed for the cost of any corrective work that the City must perform Permit Release Date Released Cash Deposit? YOU MUST CALL UNDERGROUND SERVICE ALERT (1-800-422-4133) TWO WORKING DAYS PRIOR TO WORK UNDERGROUND SERVICE ALERT NO IF ANY EXCAVATION OR BORING IS DONE THIS PERMIT IS INVALID WITHOUT THIS NUMBER PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 1 PROJECTINFORMATION PLAN CHECK NO O3okQ? &7 EST VAL Plan Ck Deposit Validated By »JyV\A Date ^/ZO //} £ Address (include Bldg/Suite tt)Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units Proposed Use Description of Work 2^|f ^CONTA^t PERSON (if different from applicant) SQ FT . #of Stories # of Bedrooms # of Bathrooms Name :3 ;?AlPPjaCANT ,_E] Contractor Address Agent fprfcfontractor QOwner City Agent fbr[Owner State/Zip Telephone?— Fax # PROPERTY OWNERrnvrtn i i w¥»i*tn—^ ^ -fa /iu g ^ ngvvQtA Coy\ o e J 'AddresName J ' Address 5 CONTRACTOR - COMPANY NAME (Sec 7031 5 Business and Professions Code Any City or County which requires a permit to construct, alter, improve, demolish or repair anV structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor s License Law [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption Any violation of Section 7031 5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]) Telephone #Name State License # Address License ClassO \ City State/Zip City Business License # Designer Name State License # 6 WORKERS' COMPENSATION Address City State/Zip Telephone Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations 0 I have and will maintain a certificate of consent to self insure for workers compensation as provided by Section 3700 of the Labor Code, for the performance of the^work for which this permit is issued [S)Q I have and will maintain workers compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is •Issued My worker's compensation insurance earner and policy number are Insurance Company ^~>VtX'Y'P, t^CAv^ C\> Policy No "i ^"Z-/(/?^ ^O^> Expiration Date tO/OV/QCO (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) ' G CERTIFICATE OF EXEMPTION I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California WARNING Failule Ao secure workers compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollafsVy 00.00okinfadUitionjto the cost ofjaohipensation damages as provided for in Section 3706 of the Labor code, interest and attorney s fees SIGNATURE ^\ (XOlV \f-if QjL$^_ykZL<^ DATE 7 OWNER-BUILNOTE&ARATION^"")TJ -":*r ^ <s':" 1 hereby affirm that|l am exempt from the Contractor's LiceiWTaw for the following reason C] I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec 7044, Business and Professions Code The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale If, however, the building or improvement is sold within one yeaT~o*jx)mpletion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale) |~1 I, as owner of the propBttY, am exclusively contracting with licensed contractors to constnjcj_lhe-project (Sec 7044 Business and Professions Code The Contractor's License Law does no>-acply to an owner of property who builds or inTBteweffTnereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law)" n I am exempt under Section _/Bo9«jgss and PrgfeeStSns Code for this reason 1 I personally plan to provide the major labor andmaf6fialsTO>s«Qstruction of the proposed property improvement l~l YES 2 I (have / have not) signed an apphcatiqpXJra building permit for the pro? 3 I have contracted with the fojjpwtng person (firm) to provide the proposed construction (inciudeTiameJ address / phone number / contractors license number) 4 I plan to providepartions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number / contracjarslicense number) 5 I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work) _____ PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR/VO/V-fl£S/D£/V7Mi BUILDING PERMITS ONLY; •••" ,ff '5*1* Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? |~l YES l~l NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district' l~l YES l~l NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? l~l YES fJ] NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT 8. ^CCWStHUCflON LENDING AGENCY:; ' •;:;:'-::':- '. ,..;y:; " •.;.,.,.:..,:, „ •°:-"' t .' ::A:|L |.-.,jHf:- I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(0 Civil Code) LENDER S NAME LENDER'S ADDRESS 9 1IS APPLICANT CERTIFICATIONSN "'E:':° ....:.,..: •;•*:"• ': 'ii:;:':' IM:'':'' '"I:..'.,hk.' I,*.. "" ""•"''•:••• I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate I agree to comply with all City ordinances and State laws relating to building construction I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES JUDGMENTS COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT OSHA An OSHA permit is required for excavations over 5 0 deep and demolition or construction of structures over 3 stories in height EXPIRATION Every permit issued by the building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is notcommenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is corrrnfenced for a period of tteodavs^Sactisu-i 106 4 4 Uniform Building Code) APPLICANT'S SIGNATURE Oft ~lnCN^ UQQ 3KJUL/V/''l DATE VHITE Fili /ELLOW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 01/24/2007 Permit* CB060789 Title CARLOS RES - 700 SF POOL/SPA Description Inspector Assignment JM 2146 CORTE MORAL Lot 0 Type POOL Sub Type Job Address Suite Location OWNER CARLOS C ANTHONY&SHARON E Owner CARLOS C ANTHONY&SHARON E Remarks Phone 6196973363 Inspector Total Time Requested By OSCAR Entered By CHRISTINE CD Description 59 Final Pool Act Comment A/a Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description 12/20/2006 59 Final Pool 12/12/2006 59 Final Pool ° 11/29/2006 69 Final Masonry 07/19/2006 55 Fence/Pre-Plaster 07/18/2006 55 Fence/Pre-Plaster 05/19/2006 23 Gas/Test/Repairs 05/19/2006 31 Underground/Conduit-Wiring 05/16/2006 23 Gas/Test/Repairs 05/16/2006 52 Underground Plumbing 05/16/2006 53 Electric/Conduit/Wiring 05/08/2006 51 Excav/Steel/Bondmg/Fence 05/08/2006 52 Underground Plumbing 05/05/2006 51 Excav/Steel/Bondmg/Fence 05/03/2006 51 Excav/Steel/Bondmg/Fence 05/02/2006 51 Excav/Steel/Bonding/Fence 05/01/2006 51 Excav/Steel/Bondmg/Fence 04/28/2006 51 Excav/Steel/Bondmg/Fence 04/27/2006 51 Excav/Steel/Bondmg/Fence Act CO CO NR AP CO AP AP CO CO CO AP AP CO NR CO CA CO CA Insp JM JM PY JM JM JM JM JM JM JM JM JM JM JM JM JM JM JM Comments EXPOSE TRACER WIRE @ POOL HTR REMOVE LOW VOLT LESS THAN 10FT DOG IN YARD NO ONE HOME/GATE LOCKED OK TO PLASTER - ALARMS OK SIDEYARD FENCE & GATE NOT 60IN AIRTEST<10LBS OK TO GUNITE POUR / SPA/ SLIDE EQUIP/LIGHTS/SLIDE DOG - NO ACCESS - NOTIFIED REINSPECT FEE DUE OSCAR SLIDE NOT PER DETAIL OSCAR City of Carlsbad Bldg Inspection Request For 05/16/2006 Permit# CB060789 Title CARLOS RES - 700 SF POOL/SPA Description Inspector Assignment JM 2146 CORTE MORAL Lot 0 Type POOL Sub Type Job Address Suite Location OWNER CARLOS C ANTHONY&SHARON E Owner CARLOS C ANTHONY&SHARON E Remarks Phone 6196973363 Inspector Total Time CD Description 23 Gas/Test/Repairs 52 Underground Plumbing 53 Electric/Conduit/Wiring Requested By OSCAR Entered By CHRISTINE Comments/Notices/Hold Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp 05/08/2006 51 Excav/Steel/Bondmg/Fence AP JM 05/08/2006 52 Underground Plumbing AP JM 05/05/2006 51 Excav/Steel/Bondmg/Fence CO JM 05/03/2006 51 Excav/Steel/Bondmg/Fence NR JM 05/02/2006 51 Excav/Steel/Bondmg/Fence CO JM 05/01/2006 51 Excav/Steel/Bondmg/Fence CA JM 04/28/2006 51 Excav/Steel/Bondmg/Fence CO JM 04/27/2006 51 Excav/Steel/Bondmg/Fence CA JM Comments OK TO GUNITE POUR / SPA/ SLIDE EQUIP/LIGHTS/SLIDE DOG - NO ACCESS - NOTIFIED REINSPECT FEE DUE OSCAR SLIDE NOT PER DETAIL OSCAR CITY OF CARLSBAD BUILDING DEPARTMENT DATE NOTICE O LOCATION PERMIT NO (760) 602-2700 1635 FARADAY AVENUE TIME X/ FOR INSPECTION CALL (760) 602-2725 RE-INSPECTION FEE DUE? L _ I YES FOR FURTHER INFORMATION, CONTACT _f S^-*" > S ~PHONE BUILDING INSPECTOR " "'CODE ENFORCEMENT OFFICER City of Carlsbad Bldg Inspection Request For 05/02/2006 Permit* CB060789 Title CARLOS RES - 700 SF POOL/SPA Description Inspector Assignment JM 2146 CORTE MORAL Lot 0 Type POOL Sub Type Job Address Suite Location OWNER CARLOS C ANTHONY&SHARON E Owner CARLOS C ANTHONY&SHARON E Remarks Phone 6196973363 Inspector Total Time CD Description 51 Excav/Steel/Bondmg/Fence Requested By OSCAR Entered By CW Act Comment f Comments/Notices/Hold Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 05/01/2006 51 Excav/Steel/Bondmg/Fence CA JM OSCAR 04/28/2006 51 Excav/Steel/Bondmg/Fence CO JM SLIDE NOT PER DETAIL 04/27/2006 51 Excav/Steel/Bondmg/Fence CA JM OSCAR CITY OF CARLSBAD BUILDING DEPARTMENT NOTICE (760) 602-2700 1635 FARADAY AVENUE DATE iJ LOCATION _ TIME L/7/4 ( /)/U0= v+^^f-trt ^5 A I//-*"-is*/ u -~ \^ PERMIT NO / J.J 0 ^y r • _ ^^ // FOR INSPECTION CALL (760) 602-2725 RE-INSPECTION FEE DUE V^M YES FORFLIRJHER INFORMATION..CONTACT /L/f}^ *? "T^P* ~~7/ /A /// ./s**^.;^ £^/U(J^ Jfft^, ^ #Mf jH 4 /^ />*<^< BfllLDING TNgpEETOR '* " " ~ l^ CODE ENFORCEMEN- PHONE ® City of Carlsbad Bldg Inspection Request For 04/28/2006 Permit* CB060789 Title CARLOS RES - 700 SF POOL/SPA Description Inspector Assignment JM 2146 CORTE MORAL Lot 0 Type POOL Sub Type Job Address Suite Location OWNER CARLOS C ANTHONY&SHARON E Owner CARLOS C ANTHONY&SHARON E Remarks Phone 6196973363 Inspector Total Time Requested By OSCAR Entered By CHRISTINE CD Description Act Comment 51 Excav/Steel/Bondmg/Fence (_j Comments/Notices/Hold Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 04/27/2006 51 Excav/Steel/Bondmg/Fence CA JM OSCAR CITY OF CARLSBAD BUILDING DEPARTMENT DATE NOTICE (760) 602-2700 1635 FARADAY AVENUE LOCATION ' PERMIT NO // - / n/. / / <j u i -;// /.,/ *- '*-*' \p ^S URTHER INFORMATION, CONT /A t*. dtts/ei£f.*. FOR INSPECTION CALL (760) 602-2725 RE-INSPECTION FEE DUE1? i YESv ' /.--*) —»^, < FOR FURTHER INFORMATION, CONTACT BUILDING INSPECTOR PHONE CODE ENFORCEMENT OFFICER City of Carlsbad Public Works — Engineering BUILDING PLANCHECK CHECKLIST POOLS BUILDING PLANCHECK NUMBER CB O(o ~ BUILDING ADDRESS PROJECT DESCRIPTION Pool ASSESSOR'S PARCEL NUMBER ENGINEERING DEPARTMENT APPROVAL The item you have submitted for review has been approved The approval is based on plans, information and/or specifications provided in your submittal, therefore, any changes to these items after this date, including field modificatjertsTftiust be reviewed by this office to insure con codes Please re; as failure resulUrTsi By rmance with applicable [|y all comments attached, structions in this report can ermit to build Date DENIAL Please see the^ attached report of deficiencies marked with/O Jflake necessary corrections to plans or specifications for compliance with applicable codes and standards Submit corrected plans and/or specifications to this office for review ATTACHMENTS Grading Permit Application Grading Permit Checklist Right-of-Way Permit Application Right-of-Way Permit Submittal Checklist and Information Sheet ENGINEERING DEPT. CONTACT PERSON NAME Taniya Barrows City of Carlsbad ADDRESS1 1635 Faraday Avenue Carlsbad, CA 92008 PHONE (760) 602-2773 H \Development Services\MASTERS\FORMS CHECKLISTS \BUILDING PLANCHECK CKLIST FORM POOLS doc Rev 8/22/96 1635 Faraday Avenue • Carlsbad, CA 92008-7314 • (76O) 602-2720 • FAX (760) 602-8562 ND/RD/ or BUILDING PLANCHECK CHECKLIST - POOLS SITE PLAN 1 Provide a fully dimensioned site plan drawn to scale Show ANorth Arrow ^'Existing & Proposed Structures Show on sjte'plan Property Lines asements ramage Patterns Existing & Proposed Slopes Topography ndicate what will happen with soil excavated from pool area Retaining Walls (location and height) Note: If excavated soil is not to be removed from property but regraded on site, show proposed elevations and slopes. If any portion of retaining walls are over 4' in height, a separate permit is required Retaining Wall Permit CB Applied for Approved 3 Include on title sheet Address B Assessor's Parcel Number '^^•Lega\ Description D Grading Quantities Cut Fill Import/Export a) If grading is not required, write "No Grading" on plot plan Project does not comply with the following Engineering Conditions of approval for Project No Conditions were complied with by GRADING PERMIT REQUIREMENTS Date The conditions that invoke the need for grading permit are found in Section 11 06 030 of the Municipal code 5a Inadequate information available on Site Plan to make a determination on grading requirements Include accurate grading quantities (cut, fill, import, export) 5b Grading Permit required A separate grading plan prepared by a registered Civil Engineer must be submitted together with the completed application form attached Note: The Grading Permit must be issued and rough grading approval obtained prior to issuance of a Building Permit Page 2 of 3 H \DevelopmentServlces\MASTERS\FORMS \CHECKLISTS \BUILDINGPLANCHECKCKLISTFORM POOLS doc Rev 8/2296 .. ST/ Q 6 Q 5c A Grading Permit has been applied for PE2 DWG Grading Inspector sign off by Date Q Q Q 5d No Grading Permit required MISCELLANEOUS PERMITS Q Q 6 A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Wav and/or private work adjacent to the public Right-of-Way A separate Right-of-Way issued by the Engineering Department is required for the following Please complete attached Right-of-Way application form and return to the Engineering Department together with the requirements on the attached Right- of-Way checklist, at the time of resubmittal Right-of-Way Permit and Pool Building Permit will be issued simultaneously 7 Remarks Page 3 of 3 H \DevelopmaitSeivices\MASTERS\FORMS CHECKLISTS BUILDING PLANCHECK CKLIST FORM POOLS (toe PLANNING/ENGINEERING APPROVALS PERMIT NUMBER ADDRESS DATE 3/a'/ RESIDENTIAL ADDITION MINOR « $10,000.00) TENANT IMPROVEMENT PLAZA CAMINO REAL CARLSBAD COMPANY STORES VILLAGE FAIRE COMPLETE OFFICE BUILDING OTHER PLANNER DATE /fa ENGINEER DATE Oocs/MUformsAMannlna Engincenna Approvafc ACQHa CERTIFICATE OF LIABILITY INSURANCE 1 oftTTaoSs James G. Parker Ins. & Associates 1753 E. nr street Fresno, CA. 93720 INSURED Azure Construction Incv 7423 El Cajon Blvd. La Mosa, CA. 91941-3401 i THIS CERTIFIC5ATE IS ISSUED AS A MATTER QP INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR r. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS* Af FORDING COVERAGE INSURER*. Lexrnaton Insurance Co» INSURERS r"«l^f,n P.*Cfl& TnRuranqe jsKurtgRC: sn-af^_ FvmA INSURERS INSURERE. COVERAGES NAIC# H£ ^^^^ilSSf^S^^JS^^f^33^ TOTHE INSURED NAMED ABOVE FOft THE POLICY PSRidP INDICATED NOTWlTHSTANCHNtS £Sv ^ffi^SfikwS*^ S^m ?v ^r??^^?^0™^ DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED gR ™SeS JjB A B C N3RC TYWOPINSUBAWO. SBrtBUALUAfllljn- _X COMMERCIAL CBNBRAL UABIUTV _. | CLAIMS,MADB LXl OCCUR GEN LAG6KBOWEUMJT APPLIES P6«. ~1«ugrn!» HLOC ftUTOKDaiLE LIABILITY X RNYA^O ALLOWNEDAUrOS SCHEDULED AUTOS HIREDAUTOS NOM.OWNBD AUTOS GARAQd UABIUTY ANY AUTO exces&uuHtieuAUABiuTY ] OCCUR fj OAIM8 MADE DEDUCTIBLE RETENT10M S WORKERS COMPENSATION AMD EMPLOYERS' LUSWJTY I ANY kkOORCTORIHtRINSR/EXECUTIVe OFRCER*ICMBEft EXCLUDED? IfytH dCiOAbevnta- SPECIAL PROVISIONS nalau OTHER fUUBY NUMBER 9289856 CBP8078927 442216905 POUc^pnEcnvEn4TK(Miu/loB^YY| 10/01/05 10/01/05 10/01/05 POLICY EXPIRATIONn^T^fMMOorvyi 10/01/0€ 10/01/06 10/01/06 LIOUT3 EACHQCDUMKONQg EpAA4AQ>& TOREM I toPKEfttlEES fEft^gci.f»y«a1 UaiEXPlAilywiwMraon) PERSONAL 1 AOV INJURY GENERAL AC SREQATC PROOUCTfi . CO W/OP AGG COIKBIN25SINI5LEUNIT (Sa tuxidont) BODILY INJURY (Per perron) BODILY INJURY(PersoJdurit) PROPERTY DAMAGE (Peracelaisv) AUTO ONLY- EAACdOBNT AUYOONLY AGG tACnOCCuRKENCS AGGREGATE U£Rtifel IW ELEACHACCIDElJT E L OIS6ASE . HH EMPLOYEE ELOtfeASC! POLICY LIMIT AZ^JDOO^OO $ _i s 1 Of)n 0(KV ii. OOO^JHlfl s nnp^ nnn i1, 000,000 $ $ s s I $ X $ 5 1 s s •L nnn.noo s i nrvn.nan <iTnnn,noo tlESCfa IM1ON or OPERATIONS ; LOCaTiflNa ( vawcUES ( EXCUISK>NSASOH> BY ENDORSEMENT i SPECIAL PROVISIONS Proof of insurance CERTIFICATE HOLDER CANCELLATION Hor information Purposes Only i SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCtiueD BEFORE TH£ EXPIRATION DATE THEREOF, THE ISSUING INSURED WlLL 4NOEAVOR TO UAH. 3Q DAYS WWTTtN NOTICE TO THE CKKTPICATe HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHAU. IUPOi£ NO OHLIOATION Oft LIABILITY Of AMY KHMO UPON THE IM3URER. ITS AGENTS OR NefffiEfESfATTVES ,. ^i/THOKtCtO KCPRESGNTATIVE ( /7/t ACORDZ*>(2U01/08) \^ / ©ACORD CORPORATION 19»8 ( Gu OD Q. UJ l CQ a uiu. i x o 08: ce 8 LU CC 81 0- -J