Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2011_PS-1101501 thru PS-1102000_ - PS-1101959

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coRl�i® CERTIFICATE OF LIABILITY INSURANCE OP ID LW DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED�AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER•HIS 9/11 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 1 : I the Ce tate holder Is an A I A I SUR ,the oli the terms and conditions of the policy,certain policies may require an endorsement A statement I must be enclorseon this certificate. If SUlON c does not life rights tto certificate holder in lieu of such endorsement(s). the PRODUCER VNIAUI NAME: Intercal Insurance Agency AlC,No,Ext: (AIC,Nc r. P.O. Box 129 AnoREss: —-- - Gustine CA 95322ODRI.A-2 AFFORDING Phone:209-854-2000 Fax:209-854-2520 CUSTOMERID#: INSURED INSURERS)AFFORDING COVERAGE � NA[C# INSURER A: Great Amerjran o. insurance c Our Lady Of Fatima Society ------ --- of Thornton INSURER B: P.O. Box 611 - Thornton CA 95686 INSURER C: INSURER D: INSURER E — — — — INSURER F. -. .—.. — COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INISURIWID, FOLICYNUMBER (MWDD/YYYYI (MW DD/YYYY), UMI"'S GENERAL LIABILITY I I EACH OCCURRENCE _ $1,000,000 _ A X COMMERCIAL GENERAL LIABILITY ! 1 IPAC 307-03-39 I05/01/11 105/01/12 PREMISES(Ea occurrence) $100,000 CLAIMS-MADE 1:X1 OCCUR I I I MED EXP(Any one person) S 5,000 PERSONAL 8 ADV INJURY _ $1,000,000 - GENERAL AGGREGATE s3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER- I PRODUCTS-COMPlOPAGG GG 7X POLICY 7 PRO- _ AUTOMOBILE LUIBILJECT LOC $ ITY I COMBINED SINGLE LIMIT ANY AUTO L(Ea accident) $ 1,000,000 i BODILY INJURY(Per person) S ALL OWNED AUTOS _ SCHEDULED AUTOS BODILY INJURY(Per accident•I S A X HIRED AUTOS I PROPERTY DAMAGE PAC 307-03-39 105/01/11 I05/01/12 ,(Peraccidenq S A I X NON-OWNED AUTOS i — -- '-- tANDEMPLOYER A Lue OCCUR EACH OCCURRENCE $ IAB CLAIMS-MADE AGGREGATE $ — ---— -- LE ��c------ ---- N $ I $ PENSATION I I W A S'LIABILITY Y/N i [TORY LIMITS C.Ell ANY PROPRIETOR/PARTNEWECUTIV OFFICERIMEMBER EXCLUDEDT /A E-L EACH ACCIDENT S (Mandatory in NH) I - - tf Yes.describe under E.LI DISEASE-EA EMPLOYE=�5 DESCRIPTION OF OPERATIONS below j Er—.LDIS—EASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space Is required) Certificate Holder is named as Additional Insured with respect to General Liability in regard to the Candle Licrht Parade being held on 10-16-10 and Queen Presentation Parade on 10-17-10. - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELU'D BEFORE CERTIFI THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN County of San Joaquin & Its ACCORDANCE WITH THE POLICY PROVISIONS. Board of Supervisors, Officers Employees and Agents P.O. Box 1810 AUTHORIZED REPRESENTATIVE Stockton, CA 95201 198r-2M ACORD CO PORA ON. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD