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COMPLIANCE INFO_2010 - 2011
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2300 - Underground Storage Tank Program
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PR0526212
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COMPLIANCE INFO_2010 - 2011
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Last modified
11/28/2023 1:15:12 PM
Creation date
9/5/2018 3:57:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO_2010 - 2011
FileName_PostFix
2010 - 2011
RECORD_ID
PR0526212
PE
2351
FACILITY_ID
FA0017737
FACILITY_NAME
CHEVRON STATION #307709*
STREET_NUMBER
10858
STREET_NAME
TRINITY
STREET_TYPE
PKWY
City
STOCKTON
Zip
95219
APN
06602015
CURRENT_STATUS
01
SITE_LOCATION
10858 TRINITY PKWY
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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Ra® CERTIFILATE OF LIABILITY INSURkiyCE OP ID Inc DATE (MMIDDlYYYY} <br />TOWN& -1 10/19/09 <br />PRODUCER I TIAIC P`CCTICIY"ATC IQ ICc11- AS A RRATTCD - LI -RNA 1-1 <br />ISU Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Atwood Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />800 Pacific Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Placerville CA 95667 <br />Phone: 530-626-2533 Fax:530-622-5221 INSURERS AFFORDING COVERAGE NAIC9 <br />INSURED .INSURER A: W—tct—tar Surplus Linos Ina <br />INSURER 8: <br />Town & Country Contractors Inc INSURER C: <br />3181A Luyung Dr2-ve INSURER D: <br />Rancho Cordova CA 95742 <br />Cgi019:I:T_W2&i <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />POLICY EFFECTIVE POLICY EXPIRATION <br />LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DDIYYYY DATE(MM1DDlYYYY) LIMITS <br />I GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1000000 <br />A <br />"X COMMERCIAL GENERALLIABIUTY <br />G22063832006 <br />10/19/09 <br />10/19/10 <br />PREMISES(Ea occurence)_ <br />$ 50000 <br />MED EXP (Any one person) <br />CLAIMS MADE X� OCCUR <br />$ 5000 <br />$ 1000000 <br />PERSONAL & ADV INJURY <br />J _ <br />GENERAL AGGREGATE <br />Is2000000 <br />PRODUCTS - COMPIOP AGG <br />$ 2000000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- <br />JECT LOC <br />– <br />AUTOMOBILE <br />LIABILITY <br />COMBINED LIMIT <br />ANY AUTO <br />(Ea accident)INGLE S <br />ALL OWNED AUTOS <br />INJURY <br />SCHEDULED AUTOS <br />:BODILY <br />(Per person) S <br />BODILY INJURY <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />(Per accident) <br />$ <br />PROPERTY DAMAGE <br />$ <br />(Per accident) <br />GARAGE LIABILITY <br />i <br />AUTO ONLY - EA ACCIDENT <br />S <br />OTHER THAN EA ACC <br />AN'1'AUTO <br />$ <br />AUTO ONLY: AGG <br />S <br />EXCESS I UMBRELLA LIABILITY <br />EACH OCCURRENCE <br />$ 4,000,000 <br />A <br />X I OCCUR n CLAIMSMADE G23804372003 10/19/09 10/19/10 <br />AGGREGATE <br />s4,000,000 <br />$ <br />$ <br />DEDUCTIBLE <br />X RETENTION SO <br />$ <br />WORKERS COMPENSATION <br />Wl, -ATU- GTHAND <br />EMPLOYERS' LIABILITY YIN <br />TORY LIMITS_ _ER <br />S <br />ANY PROPRIETOR/PARTNERJEXECLTIVE <br />E.L. EACH ACCIDENT <br />- <br />OFFICER/MEMBER EXCLUDED? <br />"- - <br />E -L DISEASE - EA EMPLOYEE <br />(Mandatory in NH{ <br />$ <br />If yes, desdrbe under <br />- - <br />E.L. DISEASE - POLICY LIMIT 1 <br />SPECIAL PROVISIONS below <br />$ <br />OTHER <br />DESCRIPTION OF OPERATIONS i LOCATIONS /VEHICLES) EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS <br />t.tK I II'IVAI t nvLUtK CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />INTERNA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL XYZ DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND I_IPON. THF INSURER ITS AC%FNT¢ nR <br />Internal. Use only l REPRESENTATIVES. <br />AUTHORIZYED REPRESENTATIVE <br />ACORD 25 (2009/01) <br />©1988-2009 ACORD CORPORATION. All riahts rasPrvari <br />The ACORD name and logo are registered marks of ACORD <br />
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