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DATE(MMIDDIYYYY) <br /> AC" oR ® CERTIFICATE OF LIABILITY INSURANCE °610612012 <br /> THI�RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). CONTACT <br /> PRODUCER NAME: FAX <br /> MARSH RISK&INSURANCE SERVICES PHONE AIC No)- <br /> 345 CALIFORNIA STREET,SUITE 1300 E-MAIL Ext <br /> -MAILIL <br /> CALIFORNIA LICENSE NO.0437153 ADDRESS: NAIC# <br /> SAN FRANCISCO,CA 94104 INSURER S AFFORDING COVERAGE 19445100 <br /> Attn:Sanfrancisco.certs@marsh.comNational Union Fire Ins Co Pittsburgh PA <br /> MN0001-GAW-STND-12-13 INSURER A <br /> INSURED <br /> INSURER B <br /> DeSilva Gates Construction,LP INSURER C <br /> 11555 Dublin Bouelvard <br /> Dublin,CA 94568 INSURER D <br /> INSURER E: <br /> INSURER F: <br /> CERTIFICATE NUMBER: SEA-002326514-01 REVISION NUMBER:7 <br /> COVERAGES <br /> H ANY <br /> IS IS TO CERTIFY iiHAT THE <br /> GPOLICIES <br /> OF SURANTERLISTED M OR CONDTION OF ANY CO NTTO <br /> OR OTHER DOCUMENT WITH RESPECT TOLI <br /> IWHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED <br /> PoL cY EFF <br /> PCLAIMS. <br /> POLICY EXP LIMITS <br /> /LTR ADDLSUBR POLICY NUMBER MM/DD MMIDDNYW <br /> TYPE OF INSURANCE 2,000,000 <br /> GL 6988562 04101/2012 0410112013 EACH OCCURRENCE $ <br /> A GENERAL LIABILITY 1,000,000 <br /> X PREMISES Ea occurrence $ — 5,000 <br /> COMMERCIAL GENERAL LIABILITY MED EXP(Any one person) $ <br /> CLAIMS-MADE OCCUR 2,000,000 <br /> PERSONAL&ADV INJURY $ _ <br /> GENERAL AGGREGATE $ 4,000,000 <br /> PRODUCTS-COMPIOP AGG $ 4,000,000 <br /> GEN' AGGREGATE LIMIT APPLIES PER: $ <br /> POLICY X PRO- X LOC COMBINED SINGLE LIMIT 2,000,000 <br /> CA 1707508 04/0112012 0410112013 Ea acadent $ <br /> A AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ <br /> X ANY AUTO BODILYINJURY(Per accident) $ — <br /> ALL OWNED SCHEDULED PROPERTY DAMAGE <br /> AUTOS AUTOS $ <br /> X X NON-OWNED Per acddent <br /> HIRED AUTOS AUTOS $ <br /> X Form MCS-90 04/011212 0410112013 25,000,000 <br /> BE 14505256 EACH OCCURRENCE $ <br /> A X UMBRELLA LIABAGGREGATE X OCCUR $ 25,000,000 <br /> EXCESS LIAB CLAIMS-MADE $ <br /> DED X RETENTION$10,000 <br /> WC 021417788 04101/2012 04/01/2013 X wC STATU- OTH- <br /> TOE A WORKERS COMPENSATION 1,000,000 <br /> AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ <br /> ANY PROPRIETOR/PARTNERIEXECUTIVE� N/A 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ <br /> (Mandatory in NH) 1,000,000 <br /> If yes,describe under E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> RE:Pavement Repair-Tracy Boulevard,Tracy,CA <br /> DGC Job No.112-121 <br /> County of San Joaquin is included as Additional Insured where required by written contract. Form CG20100704 and CG20370704 are attached. <br /> CERTIFICATE HOLDER <br /> CANCELLATION <br /> County of San Joaquin SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Risk Management Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1810 Hazelton Avenue <br /> Stockton,CA 95201 <br /> AUTHORIZED REPRESENTATIVE <br /> of Marsh Risk&Insurance Services <br /> Charles Marmolejo <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />