Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2013_PS-1302501 thru PS-1303000_ - PS-1302966

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AC"R" DATE(MM/DD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 11/06/2013 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 CONTACT NAME: HCC Specialty PHONE A/C, /C No 401 Edgewater Place,Suite 400 ADDRESS: PRODUCER Wakefield, MA 01880 CUSTOMER In#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: New Hampshire Insurance Company 23841 Lincoln Music Boosters INSURERB: United States Fire Insurance Company 6844 Alexandria Place INSURERC: Stockton,CA 95207 INSURER D: INSURER E: INSURERF: 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. INSR TYPE OF INSURANCEADDL SUM POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYY MWDD/Y GENERAL LIABILITY EACH OCCURRENCE $ 4,000,000 A X SEL083332339 11/06/2013 11/19/2013 300,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE FX]OCCUR MED EXP(Any one erson 5,000 X Host Liquor PERSONAL&ADV INJURY $ 4,000,000 B X Medical Expense US112946 11/06/2013 11/19/2013 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 X POLICY PRO- LOC $ ]i POLICY AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N FTOT I - R ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED4 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 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) The Certificate Holder is added as Additional Insured with respects to our Insured's operations only. This insurance is primary and non-contributory as required by written contract. This coverage is with respect to Annual Lincoln Band Review of Champions event to be held 11/16/2013-11/16/2013 at Lincoln High School Stockton CA CERTIFICATE HOLDER CANCELLATION County of San Joaquin-Dept Of Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1810 Hazelton Avenue IN ACCORDANCE WITH THE POLICY PROVISIONS. Stockton,CA 95205 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved.