Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2010_PS-1001500 thru PS-1002000_ - PS-1001751

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I ACORV GATE{MMR)D/YYYY) Il. . CERTIFICATE 4F LIABILITY INSURANCE DATE 01a PRODUCER (916)784-9070 FAX: (916)784-0158 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION All Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 505 Vernon Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I Roseville _ _ CA 95678 INSURERS AFFORDING COVERAGE 1 NAIC# INSURED --— -- - INSURER A:Nonprofits Ins Alliance of CA Firefighters Burn Institute -INSURERS:S:Fidelity And Deposit Company 3101 Stockton Blvd. -- ------- -- INsuRERc:North American Elite INSURER D: —r Sacramer}to CA 95820 INsuRER E: t . 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 OFD R POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' ---_T_ _____ __ POLICYEFFECTIVE POLICYEXPIRATION, - - TYPE OF INSURANCE POLICY NU MBER -- - -- -PATE(M DDECCM LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ 1$ 1100C1000 CLAIMS MADE X OCCUR 009-14425NP03.2./7/20 i DAMA TZ N xmm �$ 5001000 h^ j Q — IN orle encel A X 09 11/7/2010 MED EXP(Any one Person) $ ZO 000 X . FULL LI VOR LIAB. i jPERSONAL BADV INJURY IS 1,000,00-0- GENERAL GGREGAT GENERALAGGREGATE +S_ 2,000,000 GE, PRO•N'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AGG i$' 2,000,000 X POLICY ILOG I IMPROPER SEXUAL COND — j AUTOMOBILE LIABILITY 250,000 I !COMBINED SINGLE LIMIT ANY AUTO (Eaaccdant) is 1,000,000 AALL OWNED AUTOS 2009-14425NP011/7/2010 --- -- } - --- ---- 11/7/2009 BODILY INJURY SCHEDULED AUTOS '(Parpson) S I x HIRED AUTOS ---`-- ----- 1--- ----- BODILY INJURY j X1 NON•OWNED AUTOS (ear accident) S ~ -- -- ----—- PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT is ANY AUTO OTHER THAN EA ACC s AUTO ONLY: ----- -- AGG $ EXCESS 1 UMBRELLA LIABILITY �_ __-_ $ Q,0 0 0 0 ' I X1 EACH OCCURRENCE _ _ _00 OCCUR CLANSMADE AGGREGATE 4,000,000 s 4, AI DEDUCTIBLE !I2D09-laazsva>B 111/7/2009 11/7/2010 _ s X RETENTION S 10,004 $ WORKERS COMPENSATION is WC STATU- 0TH AND EMPLOYERS'LIABILITY ❑ —, -- ANY PROPRIETORlPARTNERIEXECUTIVe / I OFFICERIMEMBER EXCLUDED? L E l EACH ACCIDENT (Mandatory In NH) — Is - — If ym,desenbe under I E.L.DISEASE-EA EMPLOYEES_ _- SPECIAL PROVISIONS below i E.C.DISEASE•POLICY LIMIT�S g oTHERg4gL0YE8 DISHONESTY CCP 0060574 06 2/19/2010 2/19/2011 LIMITS 100,000 FORGERY/ALTERATION 1 f DEDUCTIBLES 11000 C MONEY SECURITIES ' CWB 000 3844 06 14425 f11/7/2009 11 7 2014 , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS -KIMnnn DED. - 250 THE COUNTY OF SAN JOAQUIN, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED ADDITIONAL INSURED FOR THE BOOT DRIVE HELD ON SUNDAY, SEPTEMBER 26, 2010 AT THE INTERSECTION OF MOKELUMNE ST AND LOWER SACRAMENTO RD IN WOODBRIDGE, CA. FORM CG 20 12 APPLIES. *10 DAY NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1810 E HAZELTON AVE COUNTY OF SAN JOADATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN STOCKTON, CA 95205 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 26(2009101) ©19 - 009 A ORP RATION. All rights reserved. INS025(200oosol> The ACORD name and logo are registered mark of A ORD