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COMPLIANCE INFO_PRE 2019
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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PR0231532
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
10/5/2022 11:21:35 AM
Creation date
11/8/2018 9:47:10 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0231532
PE
2351
FACILITY_ID
FA0000185
FACILITY_NAME
CITY FOOD & LIQUOR
STREET_NUMBER
16470
STREET_NAME
CAMBRIDGE
STREET_TYPE
ST
City
LATHROP
Zip
95330
APN
19643032
CURRENT_STATUS
03
SITE_LOCATION
16470 CAMBRIDGE ST
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
Scanner
KBlackwell
Supplemental fields
FilePath
\MIGRATIONS3\C\CAMBRIDGE\16470\PR0231532\COMPLIANCE INFO.PDF
QuestysFileName
COMPLIANCE INFO
QuestysRecordDate
10/22/2012 8:00:00 AM
QuestysRecordID
131132
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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ACORQ. CERTIFICATE OF LIABILITY INSURANCE W�To-2 DATE <br /> A E( 25 08 <br /> PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> TLB Insurance Services HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 3000 Oak Rd. , Suite 210 - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW: <br /> Walnut Creek CA 94597 <br /> Phone: 925-395-2600 Fax:925-287-0710 INSURERS AFFORDING COVERAGE NAIC# <br /> jINSURED INSURERA HndsOn Insurance Company <br /> INSURERS: Delos Insurance CO. <br /> Walton Engineering, Inc. INSURER C: Hartford Insurance Cc 34690 <br /> P.O. BOX 1025 INSURER D: skate Cw MSatlon Ind= Baa <br /> West Sacramento CA 95691 <br /> INSURER E: <br /> COVERAGES <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 /> LTR NS TYPE OFINSURANCE POLICY NUMBER DATE MMMD DATE MM1MD YY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE S1,000,Q0Q <br /> A X COMMERCIAL GENERAL LIABILITY FEC7001958 03/06/08 03/06/09 PREMISE$ Esamurenw S 50,000 <br /> CLAIMS MADE OCCUR MED EXP(Any one person) 55,000 <br /> PERSONAL&ADV INJURY 51,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 ._ <br /> GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO 52,000,000 <br /> PoucY X EC Lob 8m Ben. 1,000,000 <br /> AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT _ S 1,000,0.00. <br /> B X ANY AUTO DPA5501192 03/06/68 03/06/09 (Be ecoldenq <br /> ALL'OWNEDAUTOSBODILY INJURY S <br /> SCHEDULEDAUTOS (Per Penton) <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNEDAUTOS - (Per aeoldenB 5 <br /> PROPERTY DAMAGE S <br /> (Pet accident)GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $. . <br /> ..ANYtAUTO - - OTHEI}'.7`HAN EAAGO -9.. <br /> AUTO ONLY: AGO $ <br /> EXCESSNMBRELLALIABILITY I EACH OCCURRENCE $ 4,000,000 <br /> A X` ZCUR ❑ CLAIMS MADE FXS7'DO1959 03/0.6/08 03/06/09 AGGREGATE- S 4;000;'000 <br /> 5 <br /> DEDUCTIBLE _ S <br /> _. .. ...._._..RETENTION.. .5. . ._. .. .. . ..__ .. ..- . .__....._........ .__..__ .. . _.__...._ ...... _ ... ._.$. .. .. ___. . _ . <br /> WORKERS COMPENSATION AND - X TORY LIMBS ER <br /> EM PLOVERS'.LIABILITY <br /> D ANY P1tOPFifETOR/PPfiTNERIEXECUTNE 0007 .3-4_927-20.08 , 10/01/08 10/01/09 E.L.EACH ACCIDENT . 51,000,000 <br /> OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEO S 1,000,000 <br /> 9;00,dearibe under <br /> SPECIAL PROVISIONS below I I EL DISEASE-POLICY LIMIT S 1,000,000 <br /> OTHER- -.. . . : . .. <br /> A Pollution/S&0 F8C7001958 - 03/06/08 03/06/09 - Poll/E&O 1,000,000 <br /> C Installation Fltr 57MSIZ6050 1 03/06/08 03/06/09 Inst Fltr 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENOORSEMENTI SPECIAL PROVISIONS - <br /> *10 days notice applies if cancelled for non-payment of premium. <br /> CERTIFICATE HOLDER CANCELLATION <br /> TOWHOMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYSWRITrEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL <br /> TO Whom It May Concern IMPOSE N O OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR <br /> REPRESENTATIVES, <br /> AUTHORIZED REPRESENTATIVE <br /> Dennis Cote <br /> ACORD 25(2001108) © ORD CORPORATION 1998 <br />
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