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WP0037962
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4200/4300 - Liquid Waste/Water Well Permits
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WP0037962
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Entry Properties
Last modified
8/24/2018 4:57:52 PM
Creation date
8/24/2018 1:17:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0037962
PE
4365
STREET_NUMBER
17831
Direction
S
STREET_NAME
MCKINLEY
STREET_TYPE
AVE
City
LATHROP
Zip
95330
APN
19815008
ENTERED_DATE
2/16/2018 12:00:00 AM
SITE_LOCATION
17831 S MCKINLEY AVE
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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BRADL-1 OP ID <br />A` ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MAP71`1YYY) <br />1 717S/7n17 <br />THIS CERTIFICATE IS ISSUED AS A MATTER Or INFORMATION ONLY AND CONFERS NO RIOIITS UPON TIIG CCRTIFICATE 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 policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Agri -Center Insurance Agency <br />2650 W. Shaw Lane, Suite 102 <br />Fresno, CA 93711 <br />George Woesner <br />wsuREoBradley and Sons, <br />3625 S. Highland <br />Del Rey, CA 93616 <br />Loni Towner <br />559-233-0123 <br />Insurance <br />COVERAGES CERTIFICATE NUMBER REVIRinN NI IMRFR <br />THIS IS TO CERTIFY THAT -THE POLICIES OF INSURANCE -LISTED BELOW -HAVE -BEEN -ISSUED -TO THE -INSURED NAME"BOVE-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 />ILTR NSR <br />TYPE OF INSURANCE <br />ADM <br />BR VD <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />George Woesner <br />2083848564 <br />06/30/2017 <br />06/30/2018 <br />EACH OCCURRENCE $ 1,000,000 <br />PORNAAGETORENTED W $ 100,000 <br />MED EXP Any oneperson) 15,000 <br />PERSONAL&ADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑X Jp,?T F-1LOC <br />OTHER: <br />GENERAL AGGREGATE $ 2,000,000 <br />PRODUCTS - COMPIOP AGG $ 2,000'000 <br />Emp Ben. $ 1,000,000 <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED X SCHEDULED <br />AUTOS ONLY AUUTNOpSyyN <br />AIURTOS ONLY X AUTOS ONL� <br />2083848645 <br />I <br />06/3012017 <br />06/30/2018 <br />COM13I aE�DtSINGLE LIMIT $ 1,000,000 <br />(Ea accX <br />BODILY INJURY (per $ <br />BODILY INJURY accident $ <br />PPR�OPERTY DAMAGE $ <br />C <br />UMBRELLA LIAR <br />EXCESS LIAR <br />X <br />OCCUR <br />CLAIMS -MADE <br />140142589778 <br />06/30/2017 <br />06/30/2018 <br />EACH OCCURRENCE 2'000'000 <br />_ _ <br />AGGREGATE $ 2,000,000 <br />DED I X I RETENTION $ 10000 <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YINER <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />�p��FICEWME Mg�� EXCLUDED? <br />(MaMatory In NN) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />�BRWC913045 <br />01/0112018 <br />01/01/2019 <br />X PER OTH <br />EL EACH ACCIDENT $ 1,0001000 <br />EL DISEASE -EA EMPLOYEE $ 1,000,000 <br />E -L DISEASE -LICY LIMIT 11000'000 <br />B <br />Auto Physical <br />Damage <br />12083848645 <br />06/30/2017 <br />06/30/2018 <br />Compnehen Various <br />Collision Various <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER CANCFLLATION <br />FORINSU <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />FOR INFORMATIONAL PURPOSES <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />ONLY <br />AUTHOMED REPRESENTATIVE <br />George Woesner <br />ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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