Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2015_PS-1500501 thru PS-1501000_ - PS-1500977

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DATE(MWDDNYYY) A�® CERTIFICATE OF LIABILITY INSURANCE 4/21/2015 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 DiAnna Martin NAME: All-Cal Insurance Agency PHONEIAIC.No. (916)(916)784-9070 No).(916)784-0158 505 Vernon Street E-MAIL ADDRESS:dianna@all-calinsurance.com INSURER(S)AFFORDING COVERAGE NAIC X Roseville CA 95678 INSURERA:Nonprofits' Insurance Alliance of 011845 INSURED INSURERB:North American Elite Insurance_ 29700A Firefighters Burn Institute INSURER C: 3101 Stockton Blvd. INSURER D: INSURER E: ISacramento - Sacramento CA 95820 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1410104118 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 BEE14 REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBRI POLICY NUMBER MMIDCY EFF MMIDCY EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 A CLAIMS-MADE iOCCUR PREMISES(Ea occunence- $_,—_ ��J_$IM250,000 PROPER SEXUAL CONDUCT X 2014-14425NPO 11/7/2014 11/7/2015 MED EXP(Any one person) $ 26,000 / $ 250,000 PERSONAL SADV INJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X I POLICY JECT LOC i PRODUCTS-COMP/OP AGG I$ 2,000,000 I OTHER: FULL LIQUOR LIABILITY Is 1,000,000 I ! COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY I ! ! Ea accident �$ ANY AUTO If ! BODILY INJURY(Per person) s ALL OWNED SCHEDULED I BODILY INJURY(Per accident) $ ! AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED FHIRED AUTOS I AUTOS i $ X UMBRELLALIABOCCUR EACH OCCURRENCE S 4,000,000 A EXCESS LIAB HCLAIMS-MADE I AGGREGATE S 4,000,000 DED I X I RETENTION$ 10,000 X 2014-14425UMB 11/7/2014 11/7/2015 $ WORKERS COMPENSATIONER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I ER ANY PROPRIETORIPARTNERIEXECUTIVEE.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? C N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ B EMPLOYEE DISHONESTY CWB 000 3844-11 14425 11/7/2014 11/7/2015 LIMITS 100,000 FORGERY / ALTERATION DEDUCTIBLE 250 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached V more space is required) SAN JOAQUIN COUNTY PUBLIC WORKS, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES & VOLUNTEERS ARE NAMED ADDITIONAL INSURED FOR THE BOOT DRIVE TO BE HELD ON MAY 9, 2015 AT E. Hw 26 / N DUNCAN RD. FORM Cr. 20 12 APPLIES. CERTIFICATE HOLDER CANCELLATION (209)468-3000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SAN TOAQUIN COUNTY PUBLIC WORKS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN• THOMAS M. CAU ACCORDANCE WITH THE POLICY PROVISIONS. 1810 E HAZELTON AVE STOCKTON, CA 95201 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401)