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b y <br />State of California <br />California Integrated Waste Management Board <br />CERTIFICATE OF SELF-INSURANCE AND RISK MANAGEMENT <br />/If —4,4W —1 —.ro is neo 4l 1 .,4,4 off—h—f 1 <br />Operator <br />Address <br />San Joaquin County <br />Solid Waste Division <br />Annual Aggregate* <br />1810 E. Hazelton Ave., Stockton, CA 95205 <br />Risk Manager <br />Address (if different from above) <br />Richard Pietz <br />Canlis Building, Room 106 <br />North County Recycling <br />24 S. Hunter St., Stockton, CA 95202 <br />Q -NA 1A1-4- n;--1 t= rMfi !`wororf• /Cnfo Info Minn fn F=—h Pnnilif%A I IMITS OF 1 IARIL.ITY <br />Name <br />Address <br />Facility Information <br />Per Occurrence* <br />Annual Aggregate* <br />Number <br />North County Recycling <br />17720 E. Harney Lane <br />39 -AA -0022 <br />$ 1,000,000 <br />$ 1,000,000 <br />Center & Sanitary Landfill <br />Lodi, CA <br />Corral Hollow Sanitary <br />31130 S. Corral <br />39 -AA -005 <br />$ 1,000,000 <br />$ 1,000,000 <br />Landfill <br />Hollow Road <br />Tracy, CA <br />Foothill Sanitary Landfill <br />6484 N. Waverly Road <br />39 -AA -0004 <br />$ 1,000,000 <br />$ 1,000,000 <br />Linden, CA <br />Harney Lane Sanitary <br />14750 E. Harney Lane <br />39 -AA -0003 <br />$ 1,000,000 <br />$ 1,000,000 <br />Landfill <br />Lodi, CA <br />TOTAL: <br />TOTAL: <br />$ 4,000,000 <br />$ 4,000,000 <br />-Excluding legal defense costs <br />CERTIFICATION: <br />1. The operator and risk manager named above hereby certify that the facilities listed above are self-insured for third <br />party bodily injury and property damage in connection with the operator's obligation to demonstrate financial responsibility under <br />Title 27, California Code of Regulations, Division 2, Subdivision 1, Chapter 6. The coverage applies to the above -listed facility(les) <br />for accidental occurrences arising from the operations of the facility(ies). <br />2. The limits of liability are the amounts stated above for "per occurrence" and "annual aggregate", exclusive of legal <br />defense costs. <br />3. Coverage isrip •maty. <br />4. Upon request by the California Integrated Waste Management Board (CIWMB), the operator agrees to furnish to the <br />CIWMB any documents pertinent to this coverage. <br />5. Termination of this coverage, will be effective only upon written notice, sent by certified mail, and only after the <br />expiration of 60 days after a copy of such written notice is received by the CIWMB, as evidenced by the return receipt. <br />CIWMB109 (12/01) <br />Page 1 of 2 <br />