|
CERTIFICATE OF SELF-INSURANCE AND RISK MANAGEMENT
<br />Operator
<br />Operator Address
<br />Facility
<br />Solid Waste Division
<br />San Joaquin County
<br />1810 E. Hazelton Ave., Stockton, CA 95205
<br />Risk Manager
<br />Risk Manager Address
<br />Occurrence "
<br />Human Resources Division
<br />Richard Pietz
<br />44 N. San Joaquin Street, Suite 330, Stockton, CA
<br />Number
<br />1.95202
<br />Solid Waste Disposal Facilities Covered:
<br />LIMITS OF
<br />LIABILITY
<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-
<br />insured for third party bodily injury and property damage in connection with the operator's obligation
<br />to demonstrate financial responsibility under Title 14, California Code of Regulations, Division 7,
<br />Chapter 5, Article 3. The coverage applies to the above -listed facilities for accidental occurrences
<br />arising from the operations of the facilities.
<br />2. The limits of liability are the amounts stated above for "per occurrence" and "annual aggregate",
<br />exclusive of legal defense costs.
<br />3. Coverage is prima
<br />4. Upon request by the Board, the operator agrees to furnish to the Board any documents pertinent to
<br />this coverage.
<br />5. Termination of this coverage will be effective only upon written notice, sent by certified mail, and only
<br />after the expiration of 60 days after a copy of such written notice is received by the Board and the
<br />local enforcement agency for the jurisdiction in which the facility is located, as evidenced by the return
<br />receipts.
<br />PAGE 1 OF 2
<br />From CIWMB 133 (11/91)
<br />Facility
<br />Per
<br />Annual
<br />Name
<br />Address
<br />Information
<br />Occurrence "
<br />Aggregate
<br />Number
<br />North County
<br />17720 E. Harney Lane
<br />$ 1,000,000
<br />Recycling Center
<br />Lodi, CA
<br />39 -AA -0022
<br />$ 1,000,000
<br />& Sanitary Landfill
<br />Corral Hollow
<br />31130 S. Corral Hollow Rd.
<br />39 -AA -005
<br />$ 1,000,000
<br />$ 1,000,000
<br />Sanitary Landfill
<br />Tracy, CA
<br />Foothill Sanitary
<br />6484 N. Waverly Rd.
<br />39_AA_0004
<br />$ 1,000,000
<br />$ 1,000,000
<br />Landfill
<br />Linden, CA
<br />Harney Lane
<br />14750 E. Harney Lane
<br />39 -AA -0003
<br />$ 1,000,000
<br />$ 1,000,000
<br />Sanitary 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-
<br />insured for third party bodily injury and property damage in connection with the operator's obligation
<br />to demonstrate financial responsibility under Title 14, California Code of Regulations, Division 7,
<br />Chapter 5, Article 3. The coverage applies to the above -listed facilities for accidental occurrences
<br />arising from the operations of the facilities.
<br />2. The limits of liability are the amounts stated above for "per occurrence" and "annual aggregate",
<br />exclusive of legal defense costs.
<br />3. Coverage is prima
<br />4. Upon request by the Board, the operator agrees to furnish to the Board any documents pertinent to
<br />this coverage.
<br />5. Termination of this coverage will be effective only upon written notice, sent by certified mail, and only
<br />after the expiration of 60 days after a copy of such written notice is received by the Board and the
<br />local enforcement agency for the jurisdiction in which the facility is located, as evidenced by the return
<br />receipts.
<br />PAGE 1 OF 2
<br />From CIWMB 133 (11/91)
<br />
|