Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2012_PS-1201501 thru PS-1202000_ - PS-12-01603

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-DTE A CERTIFICATE OF LIABILITY INSURANCE 7iA5 (2MIDD 012�) i 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(ies)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 Greg Dohrmann CONTACT Nadine Juarez NAME: Dohrmann Insurance Agency PHONE (209)978-1400 FAIA/C o;(209)476-1414 P. O. Box 7956 ADDRESS:Iladine@Dohrins.com ADORE 3255 W. March Lane .Suite 200 INSURER(S) AFFORDING COVERAGE NAIC# Stockton CA 95267 INSURERA:Firemans Fund Insurance Cos 21873 INSURED INSURERB:National Surety Corporation 21881 Lincoln Center Merchants Assoc. INSURERC:Se oia Insurance Company 2985 374 Lincoln Center INSURER D: INSURER E: Stockton CA 95207 INSURERF: COVERAGES CERTIFICATE NUMBER:CL123706002 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDIYYYY MMIDDrY YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 E G 0 RENTED X COMMERCIAL GENERAL LIABILITY PREMDAMAISES Ea occurrence $ 100,000 A CLAIMS-MADE F OCCUR X kZC80869230 1/1/2012 1/1/2013 MED EXP(Any one person) $ 10,000 X Contractual A/I Included PERSONAL BADV INJURY $ GENERAL AGGREGATE $ 4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 4,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Eaacciden()__ 1,0 0 000 X ANY AUTO BODILY INJURY(Per person) S B ALL OWNED SCHEDULED A80287214 1/1/2012 1/1/2013 AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ n Uninsured motorist combined $ 60,000 UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 10,000,000 A X I EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000 DED I X I RETENTION$ NII FAE00048557599 1/1/2012 1/1/2013 C WORKERS COMPENSATION X WC STATU- O- - AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N f A (Mandatory in NH) WP209991-2 1/1/2012 1/1/2013 E.L.DISEASE-EA EMPLOYE $ 1 000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) San Joaquin County, its officers, and employees are added as an additional insured per the attached. Re: Lincoln Live road Closure, August 17, 2012 *(10) Ten day notice of cancellation for non-payment of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN San Joaquin County ACCORDANCE WITH THE POLICY PROVISIONS. Dept. of Public Works P.O. Box 1810 AUTHORIZED REPRESENTATIVE 1810 Hazelton Ave. Stockton, CA 95201 .� G Dohrmann/NADINE — ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD