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rA <br />State of California <br />California Integrated Waste Management Board <br />CERTIFICATE OF SELF-INSURANCE AND RISK MANAGEMENT <br />'f additional space is needed add <br />Operator <br />San Joaquin County <br />Risk Manager <br />Richard Pietz <br />Solid Wastra nicnncal r...,, -.4. ir_ a_ - <br />Address <br />Solid Waste Division <br />1810 E. Hazelton Ave., Stockton, CA 95205 <br />Address (if different from above) <br />Canlis Building, Room 106 <br />24 S. Hunter St., Stockton, CA 95202 <br />-- -- - <br />I—— <br />­. -aun r-acmty) <br />LIMI 16 <br />OF LIABILITY <br />Name <br />Address <br />Facility Information <br />Per Occurrence* <br />Annual Aggregate* <br />Number <br />North County Recycling <br />Center & Sanitary Landfill <br />17720 E. Harney Lane <br />39 -AA -0022 <br />$ 1,000,000 <br />$ 1,000,000 <br />Lodi, CA <br />Corral Hollow Sanitary <br />Landfill <br />31130 S. Corral <br />39 -AA -005 <br />$ 1,000,000 <br />$ 1,000,000 <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 />Landfill <br />14750 E. Harney Lane <br />39 -AA -0003 <br />$ 1,000,000 <br />$ 1,000,000 <br />Lodi, CA <br />TOTAL: <br />TOTAL: <br />$ 4,000,000 <br />$4,000,00 0 <br />*Fxchiriinn Innnl riafo _ ..__i <br />CERTIFICATIQN: <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(ies) <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 is prima <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 (12101) <br />Page 1 of2 <br />