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ENC2006-00092CITY OF CAMPBELL R-1 NO FEE ENCROACHMENT PERMIT Permit No ~~- ZOO(,^OGp~ 2 DEPT. OF PUBLIC WORKS X-Ref. File 70 North First St. (Non-engineered work within the public right-of-way) Application Date, O Campbell, CA 95008 ($5,000 maximum value of work) (408) 866-2150 ~ I ~ Application Expiration Date ~ 2 6,( Fax (408) 376-0958 ISSUED_ ' ~ ~ L~ - ~ ~~) j` APN ~_L `-7' Permit Expiration Date ~ ~2- 6? APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in 6 months`i'f the permit is not issued.) G A. Work address a. ~ 3 ` ~V ~ ~ ~ ~ N r ~l }~~ C. ~- ~ ~ p ~~ L B. Nature of Workv ~ ~~_`~1 C, o t~ ~tz~[. ~ ~ 1 ~ Z~ ~~] ~, ~. e~J4C~ ~xl I Lls DRs?~~~{ APP~o~N IS`xti~ ~ Ta Fat..c.o4; uT~ SP~cS P~~ I. 5 >`c.ToP. 5 ~'fG~ v3~rllD~ p~6ttc. t,~caRKS C. Attach three (3) copies of a drawing showing the location, extent and dimensions of the work. The drawing shall show the relation of the proposed work to existing improvements. When approved by the City Engineer, said drawing becomes a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture of Faithful Performance securities. NAME OF APPLICANT ~pk N ~ 3~P~N ~®~O TELEPHONE ~IoB'3~O "3~1~5 p~ ~ ~ ~ (print name) ADDRESS r~~i /mil- ~~ ~~L'~-I.D-~,~ /~1~~ Ci~ I11 ~ S~ ~ L ~ ~l~ ~ ~~~'~ E-MAIL ADDRESS `C P~ a :i,-1 ®1 K t1r ~ '['Ln ~ ~yy~ The Applicant hereby confirms that this work is being done by the property owner/applicant at their own residence The Applicant hereby agrees by affixing their signature to this permit to hold the City of Campbell, City of Campbell Redevelopment Agency, its officers, agents and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant hereby acknowledges that they have read and understand both the front and back of this permit, and that they will inform their contractor(s) of the information. ACCEPTED 4dC~+-,q ~~ ~ ~j //~li~ (Applicant/Perrnittee) (Sign) NOTES: All work shall conform with the attached approved plans and all applicable Campbell Standard Details and Conditions and applicable insurance requirements. The Contractor must have this permit and approved plans and must arrange to meet with the Public Works Inspector at the site at least two days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the inquiry identification number (Ticket No.) has been entered hereon. USA PHONE: 1-800-227-2600. TICKET NO.: Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all damages arising out of the design, installation or condition of private improvements in the public right-of--way. SPECIAL PROVISIONS -~- 1. Prior to any work, the property owner shall execute an Agreement for Priv e Improveynents in the Public Right-of-Way, which shall be recorded. _IL2. GAI.I ~~ IMPF~TtoN AT $~6- 2165 ~SYL~) Ft~ ~C(LMWt{Lk 11~Sp~CT t ~N 3. STANDARD AMOUNT RECEIPT NO. SECURITY FOR FAITHFUL PERFORMANCE (1^ OF ENG. EST.) $~ ~~_ APPROVED FOR ISS Engineer Date Permit Expires 6 Months After Date of Issuance. J:\forms\rlpermit Revised 1.20.04 ~ ~ t ~ n\~(tp. ~` \ 2~ v ~ "~( \~d~r`1 ~~ ~~ L_- 55.r I (v`~ ~N t y ~ 1 nv q ~'~ r4 ~ ~ 3` '~ .._-.....~... .~...-.r.•. S ~ G~... ~a '~ .~~:.~ ~ ~ v~ ~°-° ~ V7 -a ~ ~a \9\.i At f... ..Lw.d v C -~ y ~~ ~ -~ ,. ~ ~ No1"ti~ .v R ~~ ~ Y ~.+~~ C ~f."C ~. Tc~ ~oLl,oW CtT~' ~P~~5. ~~R t~1s~~:cTa~, 5~~.~ v~t~~-~~ v ~ t.t C 1i~toR'~.S ~; ~Sa ~..~ I ~ f! a : ~ ,ter ~ ~~„s` 3 ~ ~t ~ ~~ ~.~ 370 -3 ~~ 5 ~,x~s~i~~ ~. Q 3 ~'~C ~~-' ti __ . __.____ .._. --~---~ '' ~_ f.o ~J .~ wy V o e+~ ,. t~ ~~,~ ,,,~J I` 1020 RUFF DRIVE nncrEte~ www. valieyconcrete,com SAN JOSE, CALIFORNIA .9.~ 110 UFfICE (4D8J287-fi0.J1 FAX (4D8) 287-6D95, STATE z=c. #~ aso~7a CUSTOMEFZ: 8M PHONE: WK PHONE: i ADDRE~S~ ~ `l l '~ #~ l j~ 'yi " ~Q,~ 4 P : DATE : ~ ~ 2 ~~ ..- .~. TRACTOR AND TRUCK NO JACac HAr~R No DisPOSAL zOAD No NO CONCRETE SAWING =- SCOPE OF WORK _ _ FACE OF STEP -- - - ~-- _ _ _ - __ ___ - _ E]~OSED YES ~ ERPANSION JOINT ~ NO . \ i~ l ©~ c~,~ To TYPE DEEP C8~ c,~ isms ~; ~ r~,-. REDf+TOOD YES T i ~ ` X ~r YPE/SISE _ FINISH YE~ ROCK (~ o ~ Na ~.~ , ~ ~, TYPE/SISE ~i~ ~'u-F-- CONCRETE ?tLX NO SACK 6 ~y -~ (~, ~ ~ ~~~t: • ~'' Of.1~Y' ~tJ ~ tJ~l _ LAIC BLAG'F{ YES ~ ~~j ~. RTIRE MESH YES ~ , ( i 7 L~ , ` r {~ `,. ~ ~1 r W'~' 1C~~J OTT3ER INSTRUCTIONS : ~~ r ~ t 1 ~ ~ ~~• - ~i ~t~ ZT ~ ~ ur ~ ~ ~~t? CROSS STREETS -- ----- _ - - --- - - _ - -- ~-~; I F~j rl- _ --- ,; ~ ~.p.~- ~~ ~-~t ~1`~ ~ ~ f ~ ~~ ~ ~ / ~7 I ~. t~-s 1) NOT RESPONSIBLE FOR CRACKS. FOR JOB SCBEDUZING OR gNY OTF~R QUESTION, PLEASE CALL 287-6091 X AUTHORIZATION TD START WORK 2) NOT RESPONSIBLE FOR ANY IN-GROUND UTILfTIES. IRRIGATION LINES OR SPRINKLERS. 3) THERE WILL BEAN EXTRA CHARGE FOR CONCRETE REMOVAL THICKER THAN 4" OR STEEL REINFORCEMENT. d) NOT RESPONSIBLE FOR BLOTCHINESS. I HAVE READ AND UNDERSTAND THE ABOVE INITIAL X TOTAL .BALANCE ~' DOWN PAYMEN~ t BA.LANC~ DUE f ~ ftar.~rtCE DUE L1AY OF POUR INITIAL X INSURANCE REQUIREMENTS CHECKLIST Permit # CIP Project # Vr~. ~ L The following insuranc~ is required of all contractors working in the City of Campbell public right-of--way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Permit and work being performed under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: '`~i $1,000,000 per occurrence, and ^ $1,000,000 general aggregate limit applying separately to the project, or ~ $2,000,000 general aggre ate 'mit. '~ Policy expiration date ~ Z `~ Automotive Liability: ~r~ ~° '' = ^ "Any Auto" checked on certificate ~, $1,000,000 per accident for bodily injury and property damage ~ Policy expiration date ~'~ Workers' Compensation and Employer's Liability M ASS «~ ~ ^ Waiver of Subrogation clause $1,000,000 per accident for bo ily injury or disease ~,, Policy expiration date ....`~~ Course of Construction (if required in Special Provisions) ^ Completed value of the project ^ Policy expiration date Required Endorsements to General Liability and Automobile Liability Policies Additional Insured Endorsement ~ The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured. ~t The insurance coverage afforded to the Additional Insured is primary insurance. M/~::;..r-; _.___~-~~ ^ Cancellation area of certificate edited to delete "endeavor to" and ``but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its C~ L,~L, agents or representatives". ~},~_ ^ Workers' Compensation Insurance Sheet Submitted L~ ^ For General Contractor ~y-r-'~fx,_,,~- +Ir'I~,~F,~-~n~.~L.~ ~.--t- x,J ^ For Developer or Owner Acceptability of Insurer(s) ^ Insurer(s) has current A.M. Best Rating of A:VII and is authorized to transact business in the State of California. C~~-r}- ~: ~- . } ~ i 7~ ~ Insurance Certificate Reviewed ~. tF' 30~ ~ Initials Date _. ~ ^ Copy of Insurance Certificate placed in tickler file for month of expiration. '`~ ;~_ ~t~ ~~ j:\forms\inscklst (rev I I/99) ~ 4 JUN-01-2006 THU 04;43 PM AMu INSURANCE FAX N0, 4~" ?24 9201 P, 02 DATE {MM/DD/YY) ;~ ...: PROIwCER THIS CERTIFICATE !S ISSUED AS A MATTER OF INFORMATION AMK INSURANCE AGENCY ONLY ANQ CONFERS NO RIGHTS UPON THE CERTIFICATE L T LENS E #OB 17 011 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTAR THE COI/~RAG~ AFFQRD~p SY THE pOLICI~S BELOW. 5855 VI,P. DEL ORO COMPANIES AFFORDING COVERAGE ~AN 1~0~~ CA 9 J~ 11 ~ _ COMPANY ~T A EVEREST INDEMNITY INSURED COMPANY VALLEY CONCRETE B AMERICAN EQUITX DBA : LJ C CONCRETE COMPANY 100 RUFF DRIVE ~ SAN LTOSE CA 95110 COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEp BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY ~ PERIO INQICATED, NQTWITHSTANQINCa ANY RECaUIREMENT, TERM OR CONDI TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TWE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T}-IE TERMS , EXCLUSIONS AND CONDITIONS OF SUCH POLICII=S, LIMITS SHOWN MAY HAVE B>=l=N REDUC1=p RY PAIp CLAIMS. CO L7R TYPE OF INSURANCE pOLICV NUMBER POLICY EFFECTIVE oaTE (MMlpDIYY) POLICY EXPIRATION DATE (MM/OWYY) uMlTs GE NERAL LIABILITY ~; {] Q Q Q Q ~ ~ ~ ~ Q ~ ~ O ~ ~ ~ O 5 0 ~ ~ ~ O ~ GENERAL AGGREGATE $2 ~ O O O , O O O X COMMERCIAL GENERAL LIA0ILITY PFODUCTS - COMPIOP Atl0 $~ Q Q Q Q Q Q `::,' ~ CLAIMS MApG ~ OCCUR _ _ _ PERSONAL il, ADV INJURY r, ~ ^ T $1 O O O O O O OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE , , $1 ~ Q Q O ~ Q Q Q - FIRE DAMAGfc (Any ona flro) 9; 5 O , O O O MEO EXP (Any one person) $ 5 Q Q Q AUT OMOBILE LIABILITY CT 13 0 3 3 9 0 4 0 4 0 6 0 4 0 4 0 7 1, 0 0 0, 0 0 0 ANY AUTO COMBINED SINGLE LIMIT $ ALI. pWNEp AUTOS - ~ &CHf:pULfcO AUTOS ~ '^` ~ ~ ~ a "°` '" ~ ~ BODILY INJURY (Per ptlr-an) ,~ HIRED AuT09 ""° - BObILY INJURY ,~ NON-OWNCp AUTOS s; ~i~~ ~ 2006 (PeraeclUenl) . ~ iBLIG ~~ fy"` PROPERTY CAMAGE $ GARAGE LIABILJTY ~~ 0~ AUTO ONLY • EA ACCIpENT S ANY AUTO OTHER THAN AU70 ONLY: ' ' ACH ACCIpCNT F F .. . AOORE[iA7E $ EXCE33 LIABILITY FACI'I OCCURRI=NC!_ $ UMPRELLA FORM AGGREGATE _ S _ OTHER TFIAN UMQRELLA f-DAM __ __ __ $ WORKERS COMPENSATION AND EMPLOYER ' TORY LIMITS CR S LIABILITY EL EACH ACCIDENT 5 THE PROPRIETORI PARTNERSIGxGCUTIVE - INCL ELDISEASE-POLICY LIMIT $ QFFICERSARE: EXCL EL p1$EASI=-EA I=MPLDYEE R 4THER DESCRIPTION OF OPERAT[ONSILOCATIONS/VEMICLESlSPECIAL ITEMS T7BA: ABLE UNDERGROUND CONSTRUCTION INC/ABLE SEPTIC TANK SERVICE. (A&B?CITY OF CAMPBELT~, TTS OFFICERS, EMPLOYEES & VOLUNTEERS ARE NAMED ADDITIONAL, INSURED. T~OLICIES ARE ARZMARY OVER ANX OTHER COLLECTABLE INSURANCE. SHOULD ANY OF THE ABOYE OESCRIBEQ POLICIES BE CANCELLEC BEFORE THE CITY OF CAMPBELL EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL, PU$L T C WORKS DEPARTMENT 3 O PAYS WRITTEN NOTICE TO TWE CERTIFICATE HOLDER NAMED TO THE LEFT, ~ O NQRTH 1ST STREET BU7 FAILURE TOM SUCW NOTICE SH LL I POSE NO OBLIGATION OR uAelurv CAMPBELL CA ~ S O O ~ OF ANY KIND THE o IT NTS OR REPRESENTA71VE5. AU7H4RI2E0 REPR T VE 1 N .. .. GENERAL PERMIT CONDITIONS 1. Payment of a security to insure faithful performance and completion of the work is required. This security is refundable upon completion of the work and written acceptance by the City. 2. A one-year maintenance period for all work is requared. Such period will begin on date of acceptance by the City. It is the applicant's responsibility to remove and replace unacceptable improvements within the one-year maintenance period. 3. Refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to the Permittee. 5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, fire hydrants and water valves. 6. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 7. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 8. Adequate signing and bamcading is required on the job site. Failure to provide such signing and barricading as specified by the City Engineer may result in the City's providing such signing and barricades and charging the cost to the permittee. 9. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. 10. This permit shall be kept at the site of work and must be shown to any authorized representative of the City of Campbell or any law enforcement officer upon demand. 11. No storage of materials or equipment will be allowed near the edge of pavement, within the traveled way, or within the shoulderline, which would create a hazardous condition to the public. 12. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a separate permit may be required, nor does it relieve the Permittee of any obligation to obtain any other permit required by law. 13. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 14. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 15. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 16. Call Back (call out) due to emergencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum charge per occurrence. 18. If the public interest requires a modification of, or a departure from, the plans and specifications, the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or maintained facilities. 19. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the hest Management Practices established by the ° Santa Clara Valley Urban Runoff Pollution Prevention Program. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. .. '~ ~~ Z Applicant to J:\forms\rlpermit Revised 1.20.04 JUN-01-2006 THU 04;43 PM AMA INSURANCE FAX N0, 4(''~ ?24 9201 P, 03 #4000005121-051 VALLEY CONCRETE dba J C CONCRETE dba ABLE UNDERGROUND CONSTRUCTION INC/'ABLE SEPTIC TANK SERVICE THIS EfVaaRSEUf~ENT CHANGES THE POLICY. PLEASE REAP IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORCANIZATIC,IIV _ This endorsement modifies insurance provided under the following: Ma70R VEHICLE POLLUTION l-NA~ILI7Y COVERGE PART SCHEDULE Name of Person or organization: CITY OF .CAMPBELL Any person or Qrganization that is: 1. An owner of real or personal property on which you are performing operations, but only at the specific written request by that person or organization'to you, and only iF a. That request is made prior to the date your operations for that person or organization commenced; and b. A Certficate of Insurance evidencing that request has been issued by your authorized insurance agent or 1 raker; or 2. A contractor on whose behalf you are performing operations, but only at the specific written request by that person or organization to yau, and only iF a. That request is made prior to the date your operations for that person or organization commenced; and b. A Gertiircate of Insurance evidencing that request has been issued by your authorized insurance agent or broker. (!f no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Who Is An Insured (Section Iq is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. ECG 20 ~7~ i~ 04 Copyright, Everest Reinsurance Gampany, 2000 ^ Includes copyrighted material of Insurance Services Office. inc., with its permission Copyright, Insurance Services C7fice, Inc., 1996 Page 1 of Y JUN-01-2006 THU 04;44 PM AM-~ INSURANCE FAX N0, 4('`' ?24 9201 P, 04 ae~a1~2(-Oe la:aa YA.Y Sf15 4dts i.t +alen r! 5cnuperg snc .Alts-5J t>3Juu~ ThiIS ENaORSEMENT CHANGES THE PGIIGY, PLEASE READ IT CAREFULLY, ADDITIONA!` INSUR>~D 'This endarst3ment is EFFECTIVE June 1, 2006 `and is part df Policy Number: CT430~39 `issued to: Valley Concrete dba.l G concrete dba Able Underground Construction, lnc. '"Entry optional if shown in the Common Policy Declarations. if no entry is shown, the effective date of the endorsement is the same as the effective date of the policy. This endorsement modifies insurance provided under the following; Bl1SINESS AUTO COVERAGE FORM GARAGE COVERAGtr FORM With the respect to wverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "Insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. Name of Person(s) or Organlzauonfs); City of Campbell, Public Works Department 70 f~lortlt 1st Street Campbell, California 950013 Each person or organisation shown in the Schedule is an "insured" far Liability Coverage, but only ka the extent that person or organization qualifies as an "Insured" under the Who IS An Insured Provision contained in Section I I of the Coverage dorm. June 1, 2006 includa9 copvrlgnled material of Inaurancs Services Office, Inc„ with Its permission, T~19 (71 oay Copyright, Insurance Services Oiriea, Inc„ 1999 POLICYHOLDEI lPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION I N S U R A N C E FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 05-01-2006 GROUP: POLICY NUMBER: 1556157-2006 CERTIFICATE ID: 53 CERTIFICATE EXPIRES: 05-01-2007 05-01-2006/05-01-2007 CITY OF CAMPBELL PUBLIC WORKS DEPT 70 N 1ST STREET CAMPBELL CA 95008-1423 NG This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT fJ2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 05-01-2000 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER GILBERT, GLEN W. DBA:ABLE SEPTIC NG PO BOX 24819 SAN JOSE CA 95154 NG M0410 (RE V.2-05) PRINTED 04-18-2006 JUN-01-2006 THU 04;42 PM AMK INSURANCE FAX N0, 4('" ?24 92D1 P. 01 AMR INSURANCE AGENCY INC 6$55 VIA DEL ORO SAN JOSE CA 95X19 (800)229-9101 (40$)224,91p1 FAK(408)224-9201 T0: City Of Carnnbell FAX# 408 37fr,0958 ~, ATTN: Public Works Department TEL# .. ~_x DATE: 06/01/06 r~UtUC Vi~i7~iKa ADMINI3TRgTION IF THERE IS A PROBLEM WITH THIS TRANSMISSION, PLEASE CALL ANA SPEAK T0; NANCY HUDSON A'I EXTENSION #227. THE NUMBER OF' PAGES YOU SHOULD RECEIVE IS 0~ WHICH INCLUDES THIS TRANSMITTAL SHEET. RE: Valley Concrete dba J C Concrete dba Ab1e.Under~raund Construction Inc ACCT # OR POLICY #: MESSAGE TO RECTPYENT: Please find attached the certificate of insurance you requested If you ha~'e any, questions, or if I can be of further ass~.stance please feel free to call Sincerei.y; Sr Aceauntin~ Administrator nanevhpamkinsurance.corn NANCY HUDSON