Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2012_PS-1201001 thru PS-1201500_ - PS-12-01238

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DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE ID: nrF 05/30/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 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. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Danielle Marinello NAME: California Resident License#0757776 PHONE FAX HUB International Insurance Services Inc. (A/C,No,Exty 602 - 749-4110 (A/C,No): 866-215-0963 E-MAIL 2375 East Camelback Rd Suite 250 ADDRESS& danielle.marinello@hubinternational.com Phoenix, AZ 85016 PRODUCER CUSTOMER ID# Phone: 602-395-9111 Fax: 602-395-0222 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Philadelphia Indemnity Insurance Company 18058 Muscular Dystrophy Association, Inc. INSURER B: 25674 3300 East Sunrise Drive INSURER C Tucson, AZ 85718 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 ARE SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE 11R I ADDL SUBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY PHPK647153 A, 04lO112012 0410112013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS-MADE �OCCUR PREMISES(Ea Occurrence) $ 300,000 X BI/PD Ded:$50,000 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: 17 PRODUCTS-COMP/OPS AGG $2,000,000 POLICY PROJECT X LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea aceident) ALL OWNED AUTOS BODILY Injury(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS PROPERTY DAMAGE NON-OWNED AUTOS (Per accident) $ X UMBRELLA LIAB OCCUR EXCESS LIAB PHUB378026 04/01/2012 04/01/2013 EACH OCCURRENCE $ 1,000,000 MADE CLAIMS- A, DEDUCTIBLE $10,000 AGGREGATE $ 1,000,000 X RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WC STAT- JOTH TORY LIMIT -ER ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.EACH ACCIDENT $ If yes,describe under E.L.DISEASE—EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured—State or Political Subdivisions—Permits Endorsement CG 2012(07 98) The Certificate Holder is added as additional insured as respects to their interest in Linden Peters Fill the Boot at various location in San Juaqui County. CERTIFICATE HOLDER CANCELLATION San Joaquin County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 44 North San Joaquin St. BEFORE THE EXPIRATION DATE THEREOF,NOTICE WIL BE DELIVERED IN Stockton, CA 95202 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ff