Laserfiche WebLink
11 <br />CERTIFICATE OF SELF-INSURANCE AND RISK MANAGEMENT <br />Operator <br />Operator Address <br />Facility <br />Information <br />Solid Waste Division <br />San Joaquin County <br />1810 E. Hazelton Ave., Stockton, CA 95205 <br />Risk Manager <br />Risk Manager Address <br />Occurrence * <br />Human Resources Division <br />Richard Pietz <br />44 N. San Joaquin Street, Suite 330, Stockton, CA <br />95202 <br />Solid Waste Disposal Facilities Covered: <br />LIMITS OF <br />LIABILITY <br />Name <br />Address <br />Facility <br />Information <br />Per <br />Annual <br />Number <br />Occurrence * <br />Aggregate " <br />North County <br />Recycling Center <br />17720 E. Harney Lane <br />$ 1,000,000 <br />& Sanitary Landfill <br />Lodi, CA <br />39 -AA -0022 <br />$ 1,000,000 <br />Corral Hollow <br />31130 S. Corral Hollow Rd. <br />39 -AA -005 <br />$ 1,000,000 <br />$ 1,000,000 <br />Sanitary Landfill <br />Tracy, CA <br />Foothill Sanitary <br />6484 N. Waverly Rd. <br />39 -AA -0004 <br />$ 1,000,000 <br />$ 1,000,000 <br />Landfill <br />Linden, CA <br />Harney Lane <br />14750 E. Harney Lane <br />39 -AA -0003 <br />$ 1,000,000 <br />$ 1,000,000 <br />Sanitary Landfill <br />Lodi, CA <br />TOTAL: <br />TOTAL: <br />$ 4,000,000 <br />$ 4,000,000 <br />* Excluding legal defense costs <br />CERTIFICATION: <br />1. The operator and risk manager named above hereby certify that the facilities listed above are self- <br />insured for third party bodily injury and property damage in connection with the operator's obligation <br />to demonstrate financial responsibility under Title 14, California Code of Regulations, Division 7, <br />Chapter 5, Article 3. The coverage applies to the above -listed facilities for accidental occurrences <br />arising from the operations of the facilities. <br />2. The limits of liability are the amounts stated above for "per occurrence" and "annual aggregate", <br />exclusive of legal defense costs. <br />3. Coverage isrip mare <br />4. Upon request by the Board, the operator agrees to furnish to the Board any documents pertinent to <br />this coverage. <br />Termination of this coverage will be effective only upon written notice, sent by certified mail, and only <br />after the expiration of 60 days after a copy of such written notice is received by the Board and the <br />local enforcement agency for the jurisdiction in which the facility is located, as evidenced by the return <br />receipts. <br />From CIWMB 133 (11/91) <br />PAGE 1 OF 2 <br />