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INSTALL 2018
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0541436
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INSTALL 2018
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Entry Properties
Last modified
7/22/2020 1:59:23 PM
Creation date
11/8/2018 9:40:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2018
RECORD_ID
PR0541436
PE
2351
FACILITY_ID
FA0023750
FACILITY_NAME
AGS FUEL INC DBA CIRCLE K CHEVRON
STREET_NUMBER
1490
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95337
CURRENT_STATUS
01
SITE_LOCATION
1490 S MAIN ST
QC Status
Approved
Scanner
KBlackwell
Supplemental fields
FilePath
\MIGRATIONS3\M\MAIN\1490\PR0541436\2018 INSTALL.PDF
QuestysFileName
2018 INSTALL
QuestysRecordDate
5/2/2018 6:57:48 PM
QuestysRecordID
3878462
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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A� ® CERTIFICATE OF LIABILITY INSURANCE DA3/7/0017 <br /> 0 3/7/2017 <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 poiicy(ies) must be endorsed. If SUBROGATION IS WANED, subject to <br /> the terns 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 /> cA11 <br /> ACr Heidi Gable <br /> PRODUCER NAME: — <br /> TLB Inaurajace Services Px�NE (925)395-2600 FAX NO)..(W5)287-0710 <br /> CA License #0882095 EooSEES,heidi-gable@leavitt.com <br /> 3000 Oak Road, Suite 210 INSURIERES1 AFFORDING COVERAGE NAIC0 <br /> Walnut Creak CA 94597 INSURERAAdaIiral InSruanCS CWW=y a24856 <br /> INSURED INSu"RB:Inte on National Insurance Co=panv 29742 <br /> Walton Engineering, Inc. INsuSaRc:State Comperization Insurance Fund 35076 <br /> P.O. Box 1025 IINSURERD.Hartford Casual Insurance Company 29424 <br /> INSURERS: <br /> West Sacramento CA 95691 INSURE <br /> COVERAGES CERTIFICATE NUMBER:17/18 All Policies REVISION NUMBER: <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 RAVE BEEN REDUCED BY PAID CLAIMS. <br /> IN9R ODL SUBR POLICY EFF PC EXP UNITS <br /> LTR TYPEOFINSURANCE POLICY NUMBER <br /> R COMMERCIALGENER&L LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> ETO RE 50,000 <br /> A CLABdSNV1DE C% I OCCUR PREMISES Ea $ <br /> R Imcl, Pollution Liab. FEZ-ECC-13587-04 3/6/2017 3/6/2018 MEDEXP( ores eon S 5,000 <br /> % Incl. Professional Liab. PERSONALSAUV INJURY S 1,000,000 <br /> GEPI'L AGGREGATE LIMIT APPUES PER GENERAL AGGREGATE $ 2,000,000 <br /> % POLICY[71JPERO- E]LOC I PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> e <br /> AUTOMOBILE LIABILITY COMBINED SINGLE r $ 1,000,000 <br /> R ANY AUTO BODILYINJURY(Par Parses) $ <br /> B ALL OWNED SCHEDULED <br /> AUTOS AUTOS 12003162 T3/611017 3/6/2018 PBODILYROPS INJURY(Peraceidenq $ <br /> NON-OWNED PROPERTY DAMAGE $ <br /> R MIRED AUTOS R AUTOS i I er IS <br /> UMBRELLA ME I R OCCUR I EACH OCCURRENCE S 10,000,000 <br /> A % EXCESS UAB CLAMS—MADE AGGREGATE $ 10 000 000 <br /> 0 RET ONS F3I-EXS-13588-04 3/6/2017 3/6/2018 1 $ <br /> WORKERS COMPENSATION R PSTATI ER E TH- <br /> ANDEIIPLOYERS'LIABILITY YIN <br /> ANY PROFRIETORFARTNERIEXECUNVE EL EACH ACCDENT f 1 000 000 <br /> OFFICERIMEMBER E'(CLUOED'+ � N/A 9113339-2D16 10/1/2016 10/1/2017 1,000,000 <br /> (wendaC OFFICEW1Y in NH) EL DISEASE-EA EMPLOYE S <br /> B tlesabe under E.L.DISEASE-POLICY UMr S 1,000,000 000 000 <br /> DE RIP=ON or OPERA= N bebw <br /> D Inland Marine 5700HZC1966 3/6/2017 3/6/2018 Lknk $ 300,000 <br /> Roatad, Leased or Horromad '�Oatlut6bb' $ -- '12, 00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additir [Remris Schedule,M"be atadInd B mon•Pare Is Iequ <br /> I <br /> . 1 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> TO Whom It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Heidi Gable/AEGABL G <br /> ®1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br /> INS025(2,1140 ) <br />
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