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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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JONECOV-02 GARCIAC <br /> ACORO' OA E(MWDDff/YY) <br /> CERTIFICATE OF LIABILITY INSURANCE 2/6/2013 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON HE CERTIFICATE HOLDER.THIS <br /> GE AFFORDED BY THE POLICIES <br /> BELOW.LATHIS CERTIFICATE AFFIRMATIVELY <br /> OF INSURANCE DOES NNEGATIVELY <br /> CONST TUTEEXTEND <br /> CONTTRACT BETWEENCOVER <br /> THE SSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)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 /> CONTACT <br /> PRODUCER nNn <br /> IDA Insurance Services-ORG Ise. 949 297.5962 FA/c No: 949 297-5960130 Yantis,Suite 250 Allso Viejo,CA 92656 : /NSU S AFFORDING COVERAGE NAIC$:OneBeacon Insurance Com an 21976INSURED B:Peerless Insurance COmpan 24195Jones Covey Group,Inc. C:Granite State IDs CO 238099595 Lucas Ranch Rd Ste 100 D:Rancho Cucamonga,CA 91730 E: <br /> INSURERF: <br /> COVERAGES CERTIFICATE NUMBER: 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 /> --d— <br /> TN-5R TYPE OF INSURANCE POLICY NUMBER ifil MRID�YY LIMITS <br /> LTR <br /> GENERAL LIABILITY EACH OCCURRENCE $ 5,000,00 <br /> A X COMMERCIAL GENERAL LIABILITY 7930001440001 71112012 71112013 PREMISES aocanence $ 50'00 <br /> CIAIMS-MADE OCCUR MED EXP("one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 5,000,000 <br /> GENERAL AGGREGATE $ 5,000,00 <br /> GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 5,000,000 <br /> POLICY FRI P& LOC $ <br /> COMBINEDSI /MIT 1,000,00 <br /> AUTOMOBILE LABILITY Ea accident) <br /> B X ANY AUTO BA88NO96 711/2012 7/1/2013 BODILY INJURY(Per Person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Par ecddant) $ <br /> AUTOS AUTOS <br /> NON-OWNED ROPE <br /> ACCIDENT GE $ <br /> HIRED AUTOS gIJTOS $ <br /> UMBRELLALIAB I X I OCCUR EACH OCCURRENCE $ 2,000,00 <br /> A X EXCESS LAB 1-1 CLAIMS-MADE 7930001450001 7/1/2012 711/2013 AGGREGATE $ 2,000,00 <br /> 0. <br /> OED I X I RETENTIONS $ <br /> WORI(ERSCOMPENSATION X WC STATLL !TH <br /> AND EMPLOYERS'LIABILITY YIN 1,000,000 <br /> C ANY PROPRIETORIPARTNERIFJ(ECUTIVE N/A 0009970790 211/2013 2/111014 EL EACH ACCIDENT $ <br /> OFFICERWEMBER EXCLUDED?(Mandatory In NH) EL DISEASE-EA EMPUCYEJ$ 1,000,000 <br /> Hyestlesonbeunder <br /> CE.L DISEASE-POLICY LIMLIMIT $ 1,000,000 <br /> DESRIPTION OF OPERATIONS below <br /> A Professional Llab 7930001440001 7/1/2012 7/12013 Limit: 5,000,000 <br /> A Pollution Liability 7930001440001 7/112012 7112013 Limit: 5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,Umom apace Is required) <br /> Re:Evidence of Insurance <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 /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Jones Covey Group.Inc. AUTHORIZED REPRESENTTAATIVIE <br /> Lucas Ranch Rd <br /> Suit g+ <br /> Suite 100 /,i�iC <br /> Rancho Cucamonga,CA 91730 <br /> ©1988.2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />
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