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WP0037369
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4200/4300 - Liquid Waste/Water Well Permits
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WP0037369
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Entry Properties
Last modified
7/31/2018 1:56:23 PM
Creation date
7/31/2018 11:37:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0037369
PE
4372
STREET_NUMBER
22888
Direction
S
STREET_NAME
KASSON
STREET_TYPE
RD
City
TRACY
Zip
95304
APN
23906019
ENTERED_DATE
10/2/2017 12:00:00 AM
SITE_LOCATION
22888 S KASSON RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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09/2.5/2017 05:15 FAX 4156427055 CANON 0003/004 <br />A " al® CERTIFICATE OF LIABILITY INSURANCE <br />05/23/2017 DATE 120117 IYYYY) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poliey(ios) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement- A statement on this certificate does not confer rights to the <br />certificate_ holder in lieu of such endorsement(s). <br />PRODUCER <br />MARSH USA INC. <br />ONE TOWNE SQUARE, SUITE 1100 <br />SOUTHFIELD, MI 48076 <br />Attn: detmitgroupceptive.cerirequest@marsh.com <br />NAME' <br />PHONE Ext (FAX, No): <br />MAIL <br />ADDRESS: <br />_ <br />OL03488742-13 <br />04/01/2017 <br />INSURERS AFFORDING COVERAGE NAICN <br />_ <br />INSURER A: Zurich American Insurance Company 16535 <br />R00255 -COMP -GW -17-18 San Fr <br />INSURED <br />Smith -Emery San Francisco <br />INSURER B, American Zurich insurance Company 40142 <br />INSURER C: <br />1940 Oakdale Avenue <br />San Francisco, CA 94124 <br />INSURER D± <br />INSURER E: <br />INSURER F <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />COVERAGES CFRTIFICATF Nl1MRFR' CHI -00631182&33 RFVIRInhI NI IMRFR•8 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />(NSR <br />LTR <br />TYPE OF INSURANCE <br />ADDLISLIBR <br />POLICY NUMBER <br />EFF <br />MWDCDI <br />M WD EXP <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FqOCCUR <br />_ <br />OL03488742-13 <br />04/01/2017 <br />04/01/2018 <br />EACH OCCURRENCE $ 1,000,000 <br />DAMAGE TO RENTED <br />PRFMISES Es occurrence $ 500,000 <br />MED EXP (Any one person) $ 10,000 <br />PERSONAL $ ADV INJURY $ 1,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER' <br />X POLICY [K] PEC - F-1LOCPRODUCTS <br />OTHER: <br />GENERAL AGGREGATE s 2,000,000 <br />- COMP/OP AGG $ 2,000,000 <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />-UWED SINGLE LIMIT $ <br />Ea aedtlant <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />PROPERTY DAMAGE $ <br />Per accident <br />$ <br />UMBRELLA UAB <br />EXCESS UAB <br />HOCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED I I RETENTION $ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) <br />If es, dasuibe under <br />DESCRIPTION OF OPERATIO14S below <br />NIA <br />WC3486680-14 <br />Does not apply to the Monopolistic <br />States (ND, OH, WA, and WY), <br />Puerto Rico, or the Virgin Islands <br />r9 <br />0410112017 <br />04/0112018 <br />X SP7RTU ORH <br />_ <br />E.L. EACH ACCIDENT s 1,000,000 <br />E.L. DISEASE - EA EMPLOYE $ 1,000,000 <br />E.L. DISEASE -POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />t -:EK 1 It-IGA,I E HULL1EK C,AN(:ELLAJ IUN <br />Smith -Emery San Francisco <br />1940 Oakdale Avenue <br />San Francisco, CA 94124 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />of Marsh USA Inc. <br />John C Hurley r _ <br />0 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />Received Time Sep.25, 2017 5:26PM No -2355 <br />
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