Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2012_PS-1202001 thru PS-1202500_ - PS-12-02518

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CERTIFICATE OF LIABILITY INSURANCE DAT08/30/2012 ) 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). E PRODUCER CONTACT d AOA Risk Services South, Inc. NAME: 13HONE Franklin TN Office (AIC.No.Ext): (866) 283-7122 .No.).. (847) 953-5390 d 501 Corporate Centre Drive E-MNL suite 300 ADDRESS: O Franklin TN 37067 USA 2 INSURER(S)AFFORDING COVERAGE NAIL 0 INSURED INSURER A: XL Specialty insurance Co 37885 ARCS U.Drive, Suite 100 Inc. 630 Plaza Drive, INSURER B: Greenwich Insurance Company 22322 630 Pl Highlands Ranch CO 80129 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570047376789 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 Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MID LIMITS B GENERAL LIABILITY GEC EACH OCCURRENCE $1,000,000 X General Liability DAMMAGE TO REN $1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence CLAIMS-MADE X❑OCCUR MED EXP(Any one person) $10,000 X Contractual Liability PERSONAL 3 ADV INJURY $1,000,000 20 I GENERAL AGGREGATE $2,000,000 r GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO. FX]LOC A AUTOMOBILE LIABILITY AECO01075810 617-172-612 01 01 2013 COMBINED SINGLE LIMIT Auto (A05) Ea accident $1,000,000 A X ANY AUTO AECO01719508 01/01/2012 01/01/2013 BODILY INJURY(Per person) O ALL OWNED SCHEDULED Mass Auto Z AUTOS AUTOS BODILY INJURY(Per accident) d X HIRED AUTOSX NON-OWNED PROPERTY DAMAGE AUTOS JPer accident X Property Damage to d UMBRELLA LIAR OCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED I RETENTION A WORKERS COMPENSATION AND RWD943516306 01/01/2012 01/01/2013WC STATU-I OTH- EMPLOYERS'LIABILITY X TORY LIMITS ER ANY PROPRIETOR/PARTNER I EXECUTIVE Y/N All Other States A OFFICER/MEMBER EXCLUDED? Ell NIA RwR943516706 01/01/2012 01/01/2013 E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) State Of WI E.L.DISEASE-EA EMPLOYEE S1,000,000 Hyes,describe under Use, OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) RE: Project No. GP09BPNA.C178, Installation of four air sparge wells. N CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE x EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE _J POLICY PROVISIONS. San Joaquin County AUTHORIZED REPRESENTATIVE - Attn: Department of Public works 1810 East Hazelton Avenue o Stockton CA 95201 USA 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD