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COMPLIANCE INFO 2004 - 2008
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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ELEVENTH
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1987
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2300 - Underground Storage Tank Program
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PR0517565
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COMPLIANCE INFO 2004 - 2008
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Entry Properties
Last modified
11/19/2024 10:19:31 AM
Creation date
2/28/2019 4:21:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2004 - 2008
RECORD_ID
PR0517565
PE
2361
FACILITY_ID
FA0013503
FACILITY_NAME
SAFEWAY FUEL CENTER #2600
STREET_NUMBER
1987
Direction
W
STREET_NAME
ELEVENTH
STREET_TYPE
ST
City
TRACY
Zip
95376
CURRENT_STATUS
01
SITE_LOCATION
1987 W ELEVENTH ST
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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:RVISTAT <br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD(YYYY) <br />6/5/2007 <br />70DUCER Commercial Lines Unit (707) 769-2900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />ABD Insurance & Financial Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />1039-A N. McDowell Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Petaluma, CA 94954-5507 <br />NSURED Service Station Systems, Inc. <br />3224 Regional Parkway <br />Santa Rosa. CA 95403 <br />;OVERAGES <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A: Oak River Insurance Company 34630 <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <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 C SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />1SR <br />TR <br />D <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />ATE MM DD Y <br />POLICY EXPIRATION <br />AT M DD <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE f <br />COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />REMISES (Ea occurre 1 $ <br />MED EXP (Any one person) $ <br />CLAIMS MADE ❑ OCCUR <br />PERSONAL 8 ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ <br />POLICY PRO LOC <br />JECT <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT f <br />(Ea accident) <br />BODILY INJURY f <br />(Per person) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY f <br />(Per accident) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE f <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY • EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />ANY AUTO <br />AUTO ONLY: AGG $ <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />AGGREGATE S <br />OCCUR CLAIMS MADE <br />S <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />A <br />WORKERS COMPENSATION AND <br />2210020636071 <br />6/4/2007 <br />6/4/2008 <br />X WC SL M T DTH- <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE1 f 1,000,000 <br />OFFICERIMEMBER EXCLUDED? <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />RE: License #485184 <br />Evidence of Coverage. <br />ER <br />)Contractors State License Board <br />PO Box 26000 <br />Sacramento CA 95826 <br />ACORD 25 (2001/08) 46340 <br />CANCELLATION I en Uay Notice for Non -Payment <br />SHOULD ANY OF THE ABOVE 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 />TH RI2ED RF,P$ES N A 1 E <br />0 ACORD CORPORATION 1988 <br />
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