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COMPLIANCE INFO_2016-2018
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2300 - Underground Storage Tank Program
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PR0231356
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COMPLIANCE INFO_2016-2018
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Entry Properties
Last modified
4/7/2022 10:55:27 AM
Creation date
11/8/2018 9:36:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2016-2018
RECORD_ID
PR0231356
PE
2361
FACILITY_ID
FA0003815
FACILITY_NAME
TESORO (MOBIL) 68154
STREET_NUMBER
2500
Direction
W
STREET_NAME
LODI
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
02740006
CURRENT_STATUS
01
SITE_LOCATION
2500 W LODI AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Supplemental fields
FilePath
\MIGRATIONS3\L\LODI\2500\PR0231356\COMPLIANCE INFO.PDF
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EHD - Public
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_ • REEIVE <br /> A OCT 1 S 2016 <br /> CERTIFICATE OF LIABILITY INSURANCE RAW(MIDp yl <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFE�jS��p I 2/16/2016 <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR tLlf�}(I�'{I�1� !tA�fbHOLDER. H1 <br /> E POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWF � URER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(bs)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the form 6 and conditions of the Policy,certain policlos may ropuiro an endorsement A statement on this certificate does not confer rights to the <br /> cortificato holdor In Ileu of such endorsomcnt(ay <br /> PRODUCER <br /> mA Calderon <br /> Amorell i, Roseann 6 Associates NAME' Chris <br /> -- <br /> PHONE -- r <br /> 3333 E Concours St PHONE.EAU: (909)937-7600IAM 1902)6117-7464 <br /> Building 9-200 AO9ARSS:chriaa9arainsurance.com <br /> Ontario __ CA 91764 ------- NEOR610NAPFORMNO COVERAGE M <br /> IN URERACOlo Yy_In*MgIuRoB posI]�_ 39 9 <br /> Fuel Pros Inc., N Ra Allied P i C Insurance Is. 257 <br /> dba: Wash Pros Ina. INWNRC341dwast EaoItYV6ra GsualtV omOL 23612 <br /> 14774 Central Avenve INSURER O: <br /> Chino CA 91710 INSURER <br /> COVERAGES CERTIFICATE NUMBER.CL1593012595 P <br /> THIS IS TO CERTIFY THAT THE POLICIES UI INSURANCE LISTED SELOW HAVE BEEN ISSUED 70 THE INSURED NAN i I I ABO�FOR THE POUCY 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 BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BE_E_N REDUCED BY PAID CLAIMS. <br /> INT TYPE OF INSURANCE __._______ <br /> X COMMERCIAL GENERAL LIABILITY PODCY UMBE UMTS <br /> A CWMSMADE FX1 OCCUR EACH OCCURRENCE If 11000,000 <br /> PAC6303953ESIPJI. 6 501000 <br /> 30/1/2015 10/1/2016 MED EYP r 000 Asn P 8,000 <br /> GENL AGGREGATE LIMIT APPLIES PER; PERSONAL 6 ADV INJURY 11000,000 <br /> ❑n <br /> X POLICYLOC GENERAL AGGREGATE 6 2,000,000 <br /> RPRODUCTS•COMPICPAGO 6 2,000,000 <br /> AUTOMO68a UANUTY 6 <br /> B X ANYAUTO If 1/000/000 <br /> AUTOS BCHEOIAED BODILY INJURY(PW WNAA) 6 <br /> AUTOS AAUUTOE ACR7044793320 10/1/2016 10/1/2016 BODILY INJURY(Par <br /> HIRED, AUTO ED 4WenQ 6 <br /> let,PE-oSl_.-__ 6 <br /> A UMBRELLA W1a OCCUR M"101 t mM 0 61000 <br /> X OXCE39 Me CWMSMAOE X=304453 L/21/2016 <br /> OCCURRENCE 6 4,000 000 <br /> D R EMI <br /> 1/21/2016 10/1/2016 AGGREGATE 6 4 00 <br /> WORKERS CORS'UA UT 6 <br /> ANYEMPLOYERS' ART,gY YIN X <br /> ANY PROMEMBERi"CLUDRIFJ{ECUTNE <br /> `, (NM"d%t0q In NMI E%CLUOEDT 0NIA E.LEACAACCIOENr 6 1 000 00 <br /> (Mandto 6bo NRI 6aUMC0133329 30/1/2018 10/1/2016 <br /> Yyw6aeaMauMw EL DISEASE-EA EMPLOYE 6 1,000,000 <br /> OESCRIPTIONOPOP NATIONS elvr <br /> A Pollution Liability P E.L 01 EASE-POLICY LIMIT 000 <br /> ACE303033 10/1/2015, 10/1/2016 Pref PommD Wjon <br /> A Proreeaional Liability PACa303953 51,000,000 <br /> 10/3/2015 10/1/2016 EI WmVv Ad UMI $1,000,000 <br /> DlSCRIPDON OP OPNG1pNa rLOCA710NTIVERICLEO(gCORD 701,A66MmMIRTI1Rdu 6cMWM,ety eTNOMba4 If MM. <br /> pan H nauln4l <br /> PROOF OF INSURANCE <br /> CERTIFICATE HOLDER <br /> CANCELLATION <br /> PROOF OF INSURANCE SHOULDANYOF THEA80VE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE PATH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTAINE <br /> rig Calderon/CHRISC Llr 't9� <br /> ACORD 25(2014/01) - ®1988-2014 ACORD CORPORATION. All rights reserved. <br /> INS025 nmann The ACORD name and logo are registered marks of ACORD <br />
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