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COMPLIANCE INFO 2004 - 2012
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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Y
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YOSEMITE
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1399
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2300 - Underground Storage Tank Program
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PR0231464
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COMPLIANCE INFO 2004 - 2012
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Entry Properties
Last modified
6/17/2019 11:58:25 AM
Creation date
12/13/2018 3:43:06 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2004 - 2012
RECORD_ID
PR0231464
PE
2361
FACILITY_ID
FA0000914
FACILITY_NAME
TIGER EXPRESS STORES
STREET_NUMBER
1399
Direction
E
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
CURRENT_STATUS
01
SITE_LOCATION
1399 E YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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CERTIF ATE OF LIABILITY INSAANC wALTO-2 OP ID: SH <br />EDATE (MMroD/YYYY) <br />PRODUCER 03/06/12 <br />TLB Insurance Services 925-395-2600 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />3000 Oak Rd., Suite 210 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Walnut Creek, CA 94597 HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR <br />Dennis COLD' ALTER THF rnvGOAr_� ���,..,.._. _. __ ' <br />INSURED 9 INSURERS AFFORDING COVERAGE NAIC # <br />Walton Engineerin Inc. <br />P.O. Box 1025 INSURER& Endurance American Spec Ins Co <br />West Sacramento, CA 95691 1-SURERB Wesco Insurance Company <br />INSURER C: Praetorian Insurance Company <br />INSURER D: Harford Casualty Insurance Co <br />—_ <br />TI (E POLICIES OF INSURANCE LISI'ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIRLMEN'r, 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 TI IC POLICICS DESCRIBED HEREIN IS SUBJECT TO ALL TI IE TERMS, EXCLUSIONS AND CONDITIONS OF SUCI I <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLl11MS. <br />INS ADB' <br />POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION -- <br />rGENERALLIABILITY LIMITS <br />AEIICIALGL•NL=1tALLIAl11LITY ECC10100600103 03/06/12 03/06/13 EACIIOCCURRENCE S 1,000,00 <br />WMS MAD[ PREM( S Ea occuronco _ S 50,00 <br />OCCUR — <br />MED EXP (Any one person) $ 5,00 <br />GENT. AGGREGATE LIMIT APPLIES I'ER: <br />AUTOMOBILE LIABILITY <br />B X ANYAUIO WPA1030224 01 <br />ALL OWNLU AUTOS <br />SCI ILDULEU AU I.OS <br />I IIREU AUTOS <br />NON -OWNED AUTOS <br />GARAGE LIABILITY <br />ANY AUTO <br />EXCESS I UMBRELLA LIABILITY <br />A X OCCUR D CLAIMS MADE EXS10100600203 <br />XdDEDUCTIBLE <br />RETENTION S <br />WORKERS COMPENSATION <br />C AND EMPLOYERS' UA BILITY <br />IN <br />ANY PROPRIETORfl'AItTNER/EXECUTNE YQWC4000674 <br />OFFICE RIMEMIJEH EXCLUDED? <br />(Mandatory In NII) <br />If yos, doscribo under <br />SPCCW. PROVISIONS botow <br />OTHER <br />03/06/12 1 03/06/13 <br />03/06/12 1 03/06/13 <br />PERSONAL & ADV INJURY 3 <br />GENERAL AGGREGATE S <br />PRODUCTS - COMPIOPAGG $ <br />Emp Bon. <br />COMBINED SINGLE LIMIT $ <br />(Ea accidant) <br />BODILY INJURY 3 <br />(Per porson) <br />BODILY INJURY <br />(Par accidonl) S <br />PROPERTY DAMAGE $ <br />(Per accident) <br />AUTO ONLY - EA ACCIDENT S <br />OTHER TIUN EA ACC $ <br />AUTO ONLY: AGG $ <br />EACH OCCURRENCE $ <br />AGGREGATE S <br />E <br />S <br />S <br />10/01/11 10/01/12 .L. I ACCIDENT <br />S <br />D lPollutionIE&O �E=01100600103 03/06/12 1 03/06/13 <br />D Installation Fltr 57MSIZ6050 1 03/06/12 03/06/13 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />'10 days notice applies if cancelled for non-payment of premium. <br />TE <br />To Whom It May Concern <br />ACORD 25 (2009/01) <br />. EA <br />-Pn <br />I/E80 <br />t Fltr <br />2,000,00 <br />1,000,00 <br />1.000.00 <br />10,000,0( <br />10,000,0( <br />1,000,00 <br />1,000,00 <br />1,000,00 <br />1,000,00 <br />2,000,00 <br />CANCELLATION <br />TOWHOMI SHOULDANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZEDREPRESENTATIVEDennis Cote' <br />©1988.2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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