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<br />Sander A Kessler <br /> <br />5/27/2004 1:35 <br /> <br />PAGE 002/ 002 <br /> <br />Fax Server <br /> <br />COMPANY NAME AND Pi-wECI' <br /> <br />Western Allied Mechanical, Inc. I City of Redwood City <br /> <br />INSURANCE VERmCATION FORM <br />CITY OF REDWOOD CITY <br /> <br />It Is herebJ IDIdmtood ud asreed that lhA CollowlnJ I~ R'I8œnellil... IppUellllt to ebrs project <br />Ud th.t I". *pplkabk polJde:I :mdfor t~1$ œnc.ID u.. foil.'" conra¡e. (plttJH chfti (.;) ttJ <br />Indittll, -...,.1 <br /> <br />---2S..-Additionallmut'Ød torCenendI1ability &lid Auto lJIb11i(y Covcn¡e <br /> <br />D- Citv ðf R!dw~ CI tV. lis G)uncll ermm'¡oøians. "~ec.. board!. oftjcert!. emn1DW!l1..JI!d IItfII\Q 41 <br />addi~ðl1l11 iasumd! ~ reaœcls 10 wOl't done ~ l'1amd Iub;d. <br /> <br />'----- ~ <br /> <br />~-",----,":-,- <br /> <br />PlÙDårr eo--ga <br /> <br />--------- <br /> <br />~PriIßllrY O;Jvwa¡e. 0c0eraJ Ji3biU1)' <br />-LL-1'rimIrr)' Covm~ Á1J1G L4bility <br /> <br />With tqJBçt 10 claim IrÌdDg but oflbe q¡emtloDs a.t1be Naad Jamre4.1UCb ÏllIØr8nœ as affœdad by dW poIk:y <br />is pIimIIry and Is uot ad4itional 10 oroDlllliblltia, ...U!l.aIIJ' odlCt~caaiø4 b)' arf«dIe bfœfit ol!Jac above <br />AðdIIiDl8lImllrtd&. <br /> <br />-.------------ <br /> <br />------. <br /> <br />en.u.WRtJ/SmnhmtJ afWtrat <br />X Cnln UabiliIY. G8UOr:l1 UabWry <br />:ICfI: a UabiJUy, AÐto Liabi'lil1 <br />The JlInIÌ!I& of more tbaII rœ pcr5OD¡ :linn cr cœpotaIÌl8S as insured UJSdtt dIia policy 1haJ1110C, fQ&' tb8C tOI8óD &Ionl. <br />QIitI¡uLsh any~oflll&lbsandqaJD.støolhm:. ~ rbi, ed.cncÞQt, lUlð1bca4llU¡ofmuJdple IDrJmda, RhWJ <br />FlO! Increaso thç lOW liability of thD Compaay \DIcier ibis potIoy. <br />.--x ~C;;;ñ;;'fur CJaneqJ Uabilil)' aDd ~1Iility -- <br />[t 1. wdemood ðJ)d IIFccd thiC. die Clwot of cmçellatioa oitha Poliay fQr IIftf nIIAIt, /ncltldia, l'JOD1)4)'1œ!1t.ot <br />pseŒlÌ1tØ1, 30 dllJl1rrIUtli Mtice wÐJ be.at to the tðllawing ba!<tor by malt <br /> <br />--- <br /> <br />city ofRadWClOd Cfty <br />p.o. Bcø 391 <br />Redwood aty, CA ~ <br />ACtn; EDciDeermllnd Cbn8ttIIdSon <br />(650) 7'81).1380. PhoDl: <br />734» .J'u: <br />PU:A8B nu. JlI¡,TIŒ SPACES ULOW ÁND ~ wrm A CEaTQl1CAtJt OF lNSVRÂNa: TO <br />1'HR ADDRF.SS wnm ,.8Om. <br /> <br /> <br />Policy ND, <br />~ Date: <br /> <br />GtÞnl LbbWtt <br />VTEJ -CO-2394A350- TI L -03 <br />11/01/2003 <br />11/01/2004 <br /> <br />~plt1ltltl. n.u <br />~me tIn~ c.rrieJ'ICoIl1P.~ <br />Ållthotùed IqprmntafJ"" <br /> <br /> <br />""1'111& fOnD d- a.1 B'lodll'1lhe ca,nIT8Ctlll8ftllmfJllf. <br /> <br />..lata Llabllt)' <br />VT J-CAP.2394A362- 11 L-03 <br />11/0112003 <br />11/0112004 <br /> <br /> <br />.. ....-........... --.,. 'T' <br />