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COMPLIANCE INFO 2013-2015
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PR0518288
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COMPLIANCE INFO 2013-2015
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Entry Properties
Last modified
2/26/2021 4:34:29 PM
Creation date
11/8/2018 10:21:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2013-2015
RECORD_ID
PR0518288
PE
2361
FACILITY_ID
FA0013810
FACILITY_NAME
COSTCO WHOLESALE #658
STREET_NUMBER
3250
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95377
CURRENT_STATUS
01
SITE_LOCATION
3250 W GRANT LINE RD
P_LOCATION
03
QC Status
Approved
Scanner
WNg
Supplemental fields
FilePath
\MIGRATIONS3\G\GRANT LINE\3250\PR0518288\COMPLIANCE INFO 2013-2015.PDF
QuestysFileName
COMPLIANCE INFO 2013-2015
QuestysRecordDate
7/5/2017 11:14:25 PM
QuestysRecordID
3483232
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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ecoCERTIFICATE OF LIABILITY INSU6ANCE DATE IMM DD <br /> �� 12/16/2001414' <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 policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms 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 /> PRODUCER CONTACT Michelle Sanchez <br /> NAME: <br /> Milestone Risk Management 6 Insurance Agency FHONE (949)379-6956 FAX Not. (949)852-1131 <br /> License No. OB72766 AEbm�A�'LE��.msanchez@milestonepromise.com <br /> 8 Corporate Park, Suite 130 INSURERS AFFORDING COVERAGE NAIC# <br /> Irvine CA 92606 INSURERA:Starr Surplus Lines Insurance 13604 <br /> INSURED INSURERS American Economy Insurance Co. 19690 <br /> Wayne Perry, Inc. INSURER C:Federal Insurance Company 0281 <br /> 8281 Commonwealth Ave. INSURER D:Travelers Prop 6 Cas Cc of Amer 25674 <br /> INSUREq E <br /> Buena Park CA 90621 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:14/15 Master Cert 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 HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDL SUBIR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCEim Jim POLICY NUMBER MMIDDIYYYYJ (MMIOD/YYYYILIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISE Ea o=rrence) $ 300,000 <br /> A CLAIMS MADE OCCUR SLSLEIL72023214 2/31/2014 2/31/2015 MED EXP(Any one Pinson) IS 25,000 <br /> X Conti. Pollution Liab. $1,000,000 Each Occurence PERSONAL B ADV INJURY $ 1,000,000 <br /> X Prof Liab. Claims Made $1,000,000 Each Claim, GENERAL AGGREGATE $ 2,000,000 <br /> GENT AGGREGATE LIMIT APPLIES PER Me Subject to $2,000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 <br /> POLICYX PRO LOC olicy Aggregate Limit IS <br /> AUTOMOBILE LIABILITYOMBI ED INGLE <br /> rins LIMIT 1, 00,000 <br /> B X ANY AUTO BODILY INJURY(Per Person) $ <br /> ALL OWNED SCHEDULED 2CE2314482 2/31/2014 2/31/2015 BODILY INJURY(Per accident $ <br /> AUTOS ALIT0.S ) <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Paccident) <br /> Medical mens $ <br /> UMBRELLA UABX OCCUR EACH OCCURRENCE $ 9,000,000 <br /> A X EXCESS UAB CLAIMS-MADE AGGREGATE $ 9,000,000 <br /> DED RETENTION LSL43NV73017214 2/31/2014 2/31/2015 $ <br /> C WORKERS COMPENSATIONX WC STATU- OTH- <br /> ANDEMPLOYERS'LIABILITY Y/N <br /> ANY PROPRIETORPARTNEWEXECUTIVE E.L.EACH ACCIDENT $ 11000,000 <br /> OFFICERMEMBER EXCLUDED? N/A <br /> (Mandatory,In NH) 0044727227 2/31/2014 2/31/2015 E.L DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT $ 1.000,000 <br /> D Rented/Leased Equipment 6601479CO61 2/31/2014 2/31/2015 LIMIT $100,000 <br /> D Installation Floater 601479CB61 2/31/2014 2/31/2015 LIMIT $250,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Ulundi 101,Additional Remarks Sebodub,I1 more space is r"ulred) RECEIVED <br /> MAR 18 2015 <br /> ENVIRONMENTAL <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> "PROOF ONLY** ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> M Sanchez/MICSAN <br /> ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> INS025 2010051 01 The ACORD name and logo are registered marks of ACORD <br />
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