Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2010_PS-1000401 thru PS-1000999_ - PS-1000626

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ACORD,M CERTIFICATE OF LIABILITY INSURANCE 03/31/10�� PRODUCER 1-818-539-2300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Brokers of California, Inc. License #0726293 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 505 North Brand Boulevard, Suite 600 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glendale, CA 91203-3944 CBS Certificates®ajg.com INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA Travelers Property Casualty Cc of Amea25674 CBS Corporation CBS Television INSURERS:St Paul Fire & Marine Ins Cc .24767 2713 ROVR Drive ---- _ - INSURER C: West Sacramento, CA 95605 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.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. INSRADD'L __. _-.__-_ __.-._ __---- --------'------- A POLICY EFFECTIVE f�POLICY EXPIRATION - -- LTR POLICY NUMBER LIMITS A GENERAL LIABILITY TC2JGLSA121D6189TIL09(US*) 12/31/09 12/31/10 EACH OCCURRENCE $5,000,000 -- - B X 234D0647(Canada) 12/31/09 12/31/10 PREMISES COMMERCIAL GENERAL LIABILITYPREMISES(Ea occwence) S 5,000,000 CLAIMS MADE X OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY 55,000,000 _ GENERAL AGGREGATE S 15,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG ! S5,000,000 X POLICY -. PRO- .- __- _ _. JECT LOC A AUTOMOBILE LIABILITY TC2JCAP121D6190TIL09(IISAr 12/31/09 12/31/10 OaideDSINGLE!IMIT $3,000,000B X ANYAUTO 231D6266(Canada) 12/31/09 12/31/10 ( accident) X ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Perperson) S X HIREDAUTOS R- BODILY INJURY $ NON-OWNED AUTOS (Per accident) -- - - -- ----- PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN E-AACC S AUTOONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE _ S RETENTION $ S - -----_ WORKERS COMPENSATION AND WC STATU- OTH- i_,_ TORY LIMITSER ; EMPLOYERS'LIABILITY - - - --- ---ANY PROPRIETOR/PARTNERIEXECUTIVE !.E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S If yes,descnbeunder _..___. - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER A Auto Physical Damage TC2JCAP121D6190TIL09(IISA) 12/31/09 12/31/10 'Comprehensive Ded. 500 B 'Auto Physical Damage 231D6266(Canada) 12/31/09 12/31/10 ',Collision Ded. 500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Reference: Good Day talent Go-Carts Drive from Stockton to Elk Grove on April 09, 2010. Certificate Bolder is deemed Additional Insured as required by written or verbal contract. Please refer to attached General Liability endorsement (CG T8 31) for scope of Additional Insured status. Named Insured is a Qualified Self Insurer in the State of California for Workers' Compensation. CERTIFICATE HOLDER CANCELLATION*10 Days for Non Payment of Premium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION County of San Joaquin DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30' DAYS WRITTEN Attn: Scott Cooper NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1810 E. Hazelton IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Stockton, CA 95205 AUTHORIZED REPRESENTATIVE USA ACORD 25(2001108)rahuglen ©ACORD CORPORATION 1988 15075017