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A'CORD.' CERTIFICA- OF LIABILITY NSUr NCE PRODUCER (850) 934-0300 FAX (6~0) 934-049 s THIS Ct:I~IIPJCATE: IS ISSUE:D AS A MAI I ~[ OF NkuI~MAIIUN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Tho~ts Znsurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CA L~ cense J 0243213 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 444 Castro Street. Suite 200 INSURERSAFFORDINGCOVERAGE · Mountain V~ew, CA 9404[-2017 INSURED Robert A. Bothman, ThC. INSURERA Commercial Un,on DRA:B & B Concrete Construction INSURERB: State Comp Tns. Fund - - 650 Qu~nn Avenue - INSURERC: San 3DSC, CA 95112 ' INSURERD: I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ~NDICATED. 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. LTR TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YY) DATE (M M/DD/YY) LIMITS GENERAL LIABILITY F~784574 08/01/2001 08/01/2002 EACH OCCURRENCE $ 1,D00,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 300,000 I CLAIMS MADE IX I OCCUR MED EXP (Any one person) $ 10,000 IPoL,CY I--IL°c AUTOMOBILE LIABILITY ~ B S 12 0 7 0 8/01 / 2 0 01 0 8/01/2 0 0 2 COMBINED SINGLE LIMIT X I OCCUR ~ CLAIMS MADE AGGREGATE $ 8, ~000,000 A $ WORKERS COMPENSATION ANB 163970[-01 08/0[/200[ 08/01/2002 OTHER F~784559 08/01/2001 08/01/2002 $150,000 L~m~t form CTR attached / 10 days notice of cancellation w~11 be sent for non-payment of premium. CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER m CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TNE ~L~[ ¥ J:~ ~ EXPIRATION DATE THEREOF, THE ISSUING COMPANY WI L L ~AOA~{) MAIL