Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2015_PS-1501001 thru PS-1501500_ - PS-1501156

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,�coR CERTIFICATE OF LDATE(MIVIfDD/1'Yl'Y) 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). CONTACT DiAnna Martin PRODUCER NAME: ------ All-Cal Insurance Agency AICN PHOo No. (916)784-9070 FAX (91s)7ea-olse AIC No 505 Vernon Street ADMDRIES8:dianna@all-calinsurance.com ___ INSURER(SJAFFORDING COVERAGE _ NAIC it Roseville CA 95678 _ _ INSURERA:NOnofits' Insurance Alliance of 011845 INSURED INSURERB:North American Elite Insurance 29700A Firefighters Burn Institute INSURER C:-_____ _____ — 3101 Stockton Blvd. INSURER D: INSURER E: Sacramento CA 95820 1 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 BEEN REDUCED BY PAID CLAIMS. IN TR ADDL SUBR ! POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER I MMIDDYYYY MM/DLVYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $_ 1,000,000 IDAMAGE TO RENTED 500,000 A CLAIMS-MADE 1 X�OCCUR PREMISES Eao--rrence_ $____.__ X IMPROPER SEXUAL CONDUCT X 2014-14425NPO 11/7/2014 11/7/2015 MED EXP(Arty one person) $ 20,000 $ 250 000 / $ 250,000 PERSONAL&ADV INJURY_ $ 1,000,000 GEN'L AGGREGATE LIMB APPLIES PER: GENERAL AGGREGATE $ 2,000,000 (-- 2,000,000 POLICY❑PRO ❑LOC PRODUCTS-COMPlOP AGG $ OTHER: JECT I I I FULL LIQUOR LIABILITY is 1,000,000 COMBINED SINGLE LIMB I$ !AUTOMOBILE LIABILITY I (Ea accident) BODILY INJURY(Per person) $ ANY AUTO ALL OWNED �� SCHEDULED I j BODILY INJURY(Per accident) $ AUTOS (AUTOS PROPERTY DAMAGE NON-OWNED (Per accident) $ HIRED AUTOS AUTOS is X UMBRELLALIAB HIOCCUR I EACH OCCURRENCE 1$ 4 000 000 Ir A EXCESS LIAB CLAIMS-MADE AGGREGATE i$ _41000,000. I DED X RETENTION$ 10 000 X 2014-14425tRID 11/7/2014 11/7/2015 r— $ WORKERS COMPENSATION I PER I OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1NIA A OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under E.L DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS below B EMPLOYEE DISHONESTY CWB 000 3844-11 14425 111/7/2014 1 11/7/2015 (LIMITS 100,000 FORGERY / ALTERATION I I DEDUCTIBLE 250 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Renarks Schedule,may be attached If 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. HWY 26 / N DUNCAN RD. FORM CG 20 12 APPLIES. CERTIFICATE HOLDER CANCELLATION (209)468-3000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SAN JOAQUIN COUNTY PUBLIC WORKS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: THOMAS M. GAU 1810 E HAZELTON AVE STOCKTON, CA 95201 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CQRPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)