HomeMy WebLinkAbout2236 CORTE CICUTA; ; CB044259; Permit03-29-2005
Job Address
Permit Type
Parcel No
Valuation
Occupancy Group
# Dwelling Units
Bedrooms
Project Title
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Residential Permit Permit No CB044259
Building Inspection Request Line (760) 602-2725
2236 CORTE CICUTA CBAD
RESDNTL Sub Type
2552702900 Lot #
$5,673 00 Construction Type
Reference #
0 Structure Type
0 Bathrooms
MILLS RES 183 SF LOFT
RAD
0
NEW
Status
Applied
Entered By
Plan Approved
Issued
Inspect Area
Ong PC#
Plan Check*
ISSUED
11/23/2004
KG
03/29/2005
03/29/2005
Applicant
STEIGERWALD DOUGHERTY INC
P O BOX 884 92075
858259-5100
Owner
MILLS DAVID
2236 CORTE CICUTA
CARLSBAD CA 92009
Building Permit
Add'l Building Permit Fee
Plan Check
Add'l Plan Check Fee
Plan Check Discount
Strong Motion Fee
Park in Lieu Fee
Park Fee
LFM Fee
Bridge Fee
Other Bridge Fee
BTD #2 Fee
BTD #3 Fee
Renewal Fee
Add'l Renewal Fee
Other Building Fee
Pot Water Con Fee
Meter Size
Add'l Pot Water Con Fee
Reel Water Con Fee
$68 89 Meter Size
$0 00 Add'l Reel Water Con Fee
$44 78 Meter Fee
$0 00 SDCWA Fee
$0 00 CFD Payoff Fee
$1 00 PFF
$0 00 PFF (CFD Fund)
$0 00 License Tax
$0 00 License Tax (CFD Fund)
$0 00 Traffic Impact Fee
$0 00 Traffic Impact (CFD Fund)
$0 00 Sidewalk Fee
$0 00 PLUMBING TOTAL
$0 00 ELECTRICAL TOTAL
$0 00 MECHANICAL TOTAL
$0 00 Housing Impact Fee
$0 00 Housing InLieu Fee
Housing Credit Fee
$0 00 Master Drainage Fee
$0 00 Sewer Fee
Additional Fees
TOTAL PERMIT FEES
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$000
$2000
$000
$000
$000
$000
$000
$000
$000
$13467
Total Fees $13467 Total Payments To Date $44 78
BUILDING PLANS
IN STORAGE
ATTACHED
Balance Due $8989
Inspecto
fS86 03/29, 05 0002 C)j
CGF-"
FINAL APPROVAL
Date ^-ftS Clearance
NOTICE Please take NOTICE that 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 previously otherwise expired
39-9?
BUILDING DEPARTMENT
1635 Faraday Ave , Carlsbad, CA 92008
FOR OFFICE USE ONLY
PLAN CHECK
EST VAL
Plan Ck Deposit
Validated at 72
Date //
"-3 /
yy' / o
Address (include Bldg/Suite ft)
L&3T
Business Name (at this address)
Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units
Assessor s Parcel ft /• *.Lm
Exlstln9 Use _1 83 Ph
Proposed Use
Description of Work SQ FT
iVcotJT&CT"PERSON (if differentffnun Sppjicantb; ;„ J
#of Stories # of Bedrooms #of Bathrooms
Nami
13 APPLICANT, J>J»Contractor
Address City
Age/it for Contractor . 0 [Owner™!1 njAgeht for Owner.
State/Zip Telephone #Fax*
^bQtSfi iv
Name ' ' "" Address City State/Zip Telephone ft
\S CONTRACTORflCOMPANYNAME "!^K' •:»—•-—•: <;:^ v:.^- ••••••••••• ;— •• - .--
(Sec 7031 5 Business and Professions Code Any City or County which requires a permit to construct alter improve demolish or repair any 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/fcifril penalW\of not/morelhan five hundred dollars ($5001)
Name **J ^ or
State License #\ O \ ^ -* ?
SftJbress J ^""T">
t License Class V_D
City
> City
State/Zip
Business License ft | e
Telephone ft .
Designer Name
State License #
Address City State/Zip Telephone
COMPENSATION,
Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations
O 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
*£J 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 compejisatjpn insurance carrier and policy number are < ,
Insurance Company PohcvNo Explrat,on Date
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS)
n 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 Failure to secure workers /compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars,($4QQ<000) in addition twilliu cost Of cqnjpensation damages as provided for in Section 3706 of the Labor coda interest and attorney s fees
SIGNATURE ^- ^^V - ^ V\&\^=>-'4-<A(i/ DATE U|?v?IOH
7 bWNER^BUILDEfffelcLARATIO'N \/" "-^' '1|KV ' :; • / :
;i:'"--" " "":":J
I hereby affirm that I am exempt from the Contractor s License Law for the following reason
Q 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 year of completion the owner builder will have the burden of proving that he did not build or improve for the purpose of sale)
f~l I as owner of the property am exclusively contracting with licepsed contractors to construct the project (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 contracts for such projects with contractor(s) licensed
pursuant to the Contractor s License Law) ^^
n I am exempt under Section Business and Professions Code for this reason
1 I personally plan to provide the major labor-arid materials for construction of the proposed property improvement f~1 YES FlNO
2 I (have / have not) signed an application for a building permit for the proposed work
3 I have contracted with thefotfowing person (firm) to provide the proposed construction (include name / address / phone number / contractors license number)
4 I plan to providepoftions of the work but I have hired the following person to coordinate supervise and provide the major work (include name / address / phone
number / contractors license 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 NON RESIDENTIAL BUILDING PER*MITS ONLVil ..... 24 ; ill1" i" m.
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? O YES Q NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district' f~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 l~] 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
I hereby affirm that there is a construction lending ag ncy for the performance of the work for which this permit is issued (Sec 30970) Civil Code)
AS!:... :-..::• .i
LENDER S NAME LENDERS ADDRESS
3 APPL-ICANT CERTIFICATibN-"
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 not commenced within^lBO 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 werlrlgTOmfijenced for a fferBlij of 180 days (Section 106 4 4 Uniform Building Code)
APPLICANT S SIGNATURE
ITE File YELLOW Applicant PINK Finance
DATE lib 3 I
City of Carlsbad Bldg Inspection Request
For 05/06/2005
Permit* CB044259
Title MILLS RES 183 SF LOFT
Description
Inspector Assignment PD
2236 CORTE CICUTA
Lot 0
Type RESDNTL Sub Type RAD
Job Address
Suite
Location
APPLICANT STEIGERWALD DOUGHERTY INC
Owner MILLS DAVID
Remarks
Phone 6199219232
Inspecto
Total Time
CD Description
19 Final Structural
29 Final Plumbing
39 Final Electrical
49 Final Mechanical
Requested By MIKE
Entered By CHRISTINE
Act.- Comment
Associated PCRs/CVs
Inspection History
Date Description Act Insp Comments
03/31/2005 14 Frame/Steel/Bolting/Weldmg AP PD WAIVED DRYWALL
03/31/2005 34 Rough Electric AP PD
EsGil Corporation
In Partners Hip witfi government for <Buifding Safety
DATE 3/24/05 a APPLICANT
d5 JURIS"
JURISDICTION City of Carlsbad a PLAN REVIEWER
a FILE
PLAN CHECK NO 04-4259 SET II
PROJECT ADDRESS 2236 Corte Cicuta
PROJECT NAME Mills Residence Addition
IXI The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes
The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck
The check list transmitted herewith is for your information The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck
The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person
The applicant's copy of the check list has been sent to
XI Esgil Corporation staff did not advise the applicant that the plan check has been completed
Esgil Corporation staff did advise the applicant that the plan check has been completed
Person contacted Telephone #
Date contacted (by ) Fax #
Mail Telephone Fax In Person
XI REMARKS City to field verify that the first floor room where the proposed loft open into have 1
5080 door and two 2660 slider window
By David Yao Enclosures
Esgil Corporation
D GA D MB D EJ D PC 3/17 trnsmtldot
9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 * (858)560-1468 * Fax (858) 560-1576
EsGii Corporation
In <PartnersHip with government for <&uif<ftng Safety
DATE 12/7/O4
JURISDICTION City of Carlsbad a PLAN REVIEWER
a FILE
PLAN CHECK NO 04-4259 SET I
PROJECT ADDRESS 2236 Corte Cicuta
PROJECT NAME Milb Residence Addition
The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes
The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
and should be corrected and resubmitted for a complete recheck
The check list transmitted herewith is for your information The plans are being held at Esgil
Corporation until corrected plans are submitted for recheck
The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant
contact person
The applicant's copy of the check list has been sent to
David Steigerwsld P O Box 884 Solana Beach, CA
|_| Esgil Corporation staff did not advise the applicant that the plan check has been completed
Esgil Corporation staff did advise the applicant that the plan check has been completed
Person contacted David Steigerwsld Telephones (858)259-5100
Date contacted M/y^ (by j^ ) Fax # * >-? - ffr <•/
Mail— ^felephoneL-/ Fax -"m Person
REMARKS
By David Yao Enclosures
Esgil Corporation
D GA D MB D EJ D PC 12/2 trnsmtldot
9320 Chesapeake Drive, Suite 208 4 San Diego, California 92123 * (858)560-1468 * Fax (858) 560-1576
City of Carlsbad 04-4259
12/7/O4
PLAN REVIEW CORRECTION LIST
SINGLE FAMILY DWELLINGS AND DUPLEXES
PLAN CHECK NO O4-4259 JURISDICTION City of Carlsbad
PROJECT ADDRESS 2236 Corte Cicuta
FLOOR AREA
Living addition 183 sf
REMARKS
DATE PLANS RECEIVED BY
JURISDICTION
DATE INITIAL PLAN REVIEW
COMPLETED 12/7/04
STORIES 2
HEIGHT
DATE PLANS RECEIVED BY
ESGIL CORPORATION 12/2
PLAN REVIEWER David Yao
FOREWORD (PLEASE READ)
This plan review is limited to the technical requirements contained in the Uniform Building Code,
Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws
regulating energy conservation, noise attenuation and access for the disabled This plan review
is based on regulations enforced by the Building Department You may have other corrections
based on laws and ordinance by the Planning Department, Engineering Department, Fire
Department or other departments Clearance from those departments may be required prior to
the issuance of a building permit
Present California law mandates that residential construction comply with the 2001 edition of
the California Building Code (Title 24), which adopts the following model codes 1997 UBC,
2000 UPC, 2000 UMC and 1999 NEC (all effective 11/1/02)
The above regulations apply to residential construction, regardless of the code editions adopted
by ordinance
The following items listed need clarification, modification or change All items must be satisfied
before the plans will be in conformance with the cited codes and regulations Per Sec 106 4 3,
1997 Uniform Building Code, the approval of the plans does not permit the violation of any
state, county or city law
To speed up the recheck process, please note on this list (or a copy) where each
correction item has been addressed, i e , plan sheet number, specification section, etc
Be sure to enclose the marked up list when you submit the revised plans
City of Carlsbad 04-4259
12/7/04
Please make all corrections on the original tracings, as requested in the correction list
Submit three sets of plans for commercial/industrial projects (two sets of plans for
residential projects) For expeditious processing, corrected sets can be submitted in one
of two ways
1 Deliver all corrected sets of plans and calculations/reports directly to the City of
Carlsbad Building Department, 1635 Faraday Ave , Carlsbad, CA 92008, (760) 602-
2700 The City will route the plans to EsGil Corporation and the Carlsbad Planning,
Engineering and Fire Departments
2 Bring one corrected set of plans and calculations/reports to EsGil Corporation, 9320
Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468 Deliver all
remaining sets of plans and calculations/reports directly to the City of Carlsbad Building
Department for routing to their Planning, Engineering and Fire Departments
1 Indicate on the Title Sheet of the plans the name of the person responsible for
the preparation of the plans Section 106 3 3
2 All sheets of plans must be signed by the person responsible for their
preparation (California Business and Professions Code)
3 Show locations of permanently wired smoke detectors with battery backup
a) Inside each bedroom
b) Centrally located in corridor or area giving access to sleeping rooms
c) On each story
d) When sleeping rooms are upstairs, at the upper level in close proximity to
the stair
e) In rooms adjacent to hallways serving bedrooms, when such rooms have
a ceiling height 24 inches or more above the ceiling height in the hallway
NOTE Detectors shall sound an alarm audible in all sleeping areas of the unit
Section 3109 1
4 When the valuation of a room addition or repair exceeds $1,000, or when
sleeping rooms are created, smoke detectors shall be provided per the above,
except that smoke detectors added at existing construction need only be battery
powered Section 310 9 1 2
5 Window area must be at least 1/10 of the floor area and a minimum of 10 square
feet per Section 1203 3 (The nature light and ventilation appears to be provide
by the windows or doors at lower floor Provide lower floor plan with window size
and type to show the windows at lower floor can provide adequate nature light
and ventilation for the floor area at first floor plus the loft area )
6 Openable window area in habitable rooms must be 1/20 of the floor area and a
minimum of 5 square feet In bathrooms and water closet compartments, 1/20 of
area is required and minimum is 1 5 sq ft Section 1203 3 (see item 5)
7 Note on the plans that receptacle outlet locations will comply with NEC Art
210-52(a)
City of Carlsbad O4-4259
12/7/04
8 To speed up the review process, note on this list (or a copy) where each
correction item has been addressed, i e , plan sheet, note or detail number,
calculation page, etc
9 Please indicate here if any changes have been made to the plans that are not a
result of corrections from this list If there are other changes, please briefly
describe them and where they are located in the plans
• Have changes been made to the plans not resulting from this correction list/?
Please indicate
Yes Q No a
10 The jurisdiction has contracted with Esgil Corporation located at 9320
Chesapeake Drive, Suite 208, San Diego, California 92123, telephone number of
858/560-1468, to perform the plan review for your project If you have any
questions regarding these plan review items, please contact David Yao at Esgil
Corporation Thank you
City of Carlsbad O4-4259
12/7/04
VALUATION AND PLAN CHECK FEE
JURISDICTION City of Carlsbad
PREPARED BY David Yao
BUILDING ADDRESS 2236 Corte Cicuta
PLAN CHECK NO 04-4259
DATE 12/7/04
BUILDING OCCUPANCY R-3 TYPE OF CONSTRUCTION V-N
BUILDING
PORTION
living addition
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code
AREA
( Sq Ft )
183
cb
Valuation
Multiplier
By Ordinance
Reg
Mod
per city
VALUE ($)
5,673
5,673
Bldg Permit Fee by Ordinance
Plan Check Fee by Ordinance
Type of Review
EH Repetitive Fee
Repeats
Complete Review
D Other
D Hourly
Structural Only
Hour
Esgil Plan Review Fee
$68 891
$4478
$3858
Comments
Sheet 1 of 1
macvalue doc
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB DATE
ADDRESS
TENANT IMPROVEMENT
RESIDENTIAL ADDITION MINOR
« $10,000.00)
OTHER
PLAZA CAMINO REAL
CARLSBAD COMPANY STORES
VILLAGE FAIRE
COMPLETE OFFICE BUILDING
PLANNER DATE
ENGINE DATE
Client* 10454 3STEI
ACORD- CERTIFICATE OF LIABILITY INSURANCE SET"*
PRODUCER
rimothy S Mills Insurance
HRH - San Diego Division
9339 Genesee Avenue, Suite 300
San Diego, CA 92121
INSURED
Steigerwald-Dougherty, Inc
PO Box 884
Solana Beach, CA 92075
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
INSURERS AFFORDING COVERAGE
INSURER A. NIC Insurance Company
INSURER B State Compensation Insurance Fund (C
INSURER C
INSURER D
INSURER E.
NAIC#
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR
LTR
A
A
B
MD'l
NSRC TYPE OF INSURANCE
GENERAL LIABILITY
X_
X
COMMERCIAL GENERAL LIABILITY
1 CLAIMS MADE | X| OCCUR
BI/PD Ded 5,000
GEN L AGGREGATE LIMIT APPLIES PER.
~~1 POLICY! |jPH°f | |LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS/UMBRELLA LIABILITY
X 1 OCCUR 1 | CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes describe under
SPECIAL PROVISIONS below
OTHER
POLICY NUMBER
GS411286*
XS400942*
0460010077504*
POLICY EFFECTIVE
DATE/MM/DD/YY)
09/01/04
09/01/04
09/01/04
POLICY EXPIRATION
DATEWM/DDTYY)
09/01/05
09/01/05
09/01/05
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISFS (Ea occurrence!
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS COMP/OPAGG
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Par acodent)
AUTO ONLY EA ACCIDENT
OTHFR THAN ^* ACC
AUTO ONLY AGQ
EACH OCCURRENCE
AGGREGATE
v WC STATU- OTH-
•* TORY LIMITS ER
EL EACH ACCIDENT
EL DISEASE EA EMPLOYEE
EL DISEASE POLICY LIMIT
$1.000,000
$50,000
$5,000
$1,000,000
$2,000,000
$1,000,000
$
$
$
$
$
I
$
$2,000,000
$2,000,000
$
$
$
$1,000,000
$1,000,000
$1,000,000
CERTIFICATE HOLDER CANCELLATION
Proof of Insurance
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3f>* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL
jMpesfttw-eBUGATjoN OR LIABILITY OF ANY KIND UPON THE INSURER, rrs AGENTS OR
REPRESENTATIVES ^"^^/\ /-\ A S\
AUTHORIZED 1
ACORD 25 (2001/08)1 of 2 #M364232 ^-- -
7^A|^|7 (JyWW^^
3ACLA e ACQBB-etSRPORATION 1988
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