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CALIFORNIA JOINT POWERS <br /> RISK MANAGEMENT AUTHORITY <br /> Accredited with Excellence from the California Association of Joint Powers Authorities <br /> CERTIFICATE OF COVERAGE <br /> Certificate Holder and <br /> Additional Covered Party: County of San Joaquin <br /> 44 North San Joaquin Street <br /> Stockton, CA 95202 <br /> Scott Copper,Engineering Assistant <br /> This certifies that the coverage <br /> Described herein has been issued to: City of Lodi <br /> Description of Activity: The City of Lodi requires an encroachment permit from San Joaquin County to place <br /> traffic control barricades/signage for the AMGEN tour. <br /> Date(s)of Activity: May 08,2015 to May 12,2015 <br /> Location of Activity: <br /> Lodi and San Joaquin County,CA <br /> Entity Providing Coverage Excess Coverage Certificate <br /> Expiration Date <br /> California Joint Powers Risk Management Authority $500,000 May 13,2015 <br /> excess of <br /> $500,000 <br /> The following coverage is in effect and is provided through participation in a risk sharing joint powers authority: <br /> general liability and automobile liability pooled self-insurance,as defined in the Memorandum of Coverage on file <br /> with the entity and which will be made available upon request. <br /> The coverage being provided is limited to the activity and the time period indicated herein and is subject to all the <br /> terms,conditions and exclusions of the Memorandum of Coverage of the California Joint Powers Risk Management <br /> Authority. <br /> Pursuant to Section 1I, subsection 8,relating to the definition of a covered party,the certificate holder named herein <br /> is only an additional covered party for covered claims arising out of the activity described herein and is subject to <br /> the limits stated herein. <br /> Coverage is in effect at this time and will not be cancelled, limited or allowed to expire at a date other than that <br /> indicated herein except upon 30 days written notice to the certificate holder. <br /> M -04 2015 <br /> '`.Date <br /> ,3 <br /> i <br /> David J.Clovis ARM,General Manager <br /> Authorized Signature Name and Title(Print or type) <br /> Form C <br /> 3201 Doolan Road,Suite 285 Livermore,CA 94551 •Phone(925)837-0667•FAX(925)290-1543 <br />