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FIELD DOCUMENTS
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3500 - Local Oversight Program
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PR0544222
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Last modified
3/5/2019 2:02:19 PM
Creation date
3/5/2019 11:43:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0544222
PE
3528
FACILITY_ID
FA0005976
FACILITY_NAME
TIRE & WHEEL MASTERS
STREET_NUMBER
814
Direction
E
STREET_NAME
CHARTER
STREET_TYPE
WAY
City
STOCKTON
Zip
95206
APN
16718101
CURRENT_STATUS
02
SITE_LOCATION
814 E CHARTER WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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WNg
Tags
EHD - Public
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—I—ACQRD. CERTIFICATE OFLIABILITY INSURANCE ' 10/12/07 ""' <br /> PRODUCER LIC #0726293 1-925-460-9900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Arthur 0'. .Gallagher & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> Insurance srokeral of California, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 4" <br /> ' Hacienda -Drive, #300 ALTER THE COVERAGE AFFORDED BY T114E POLICIES BELOW. <br /> Pi..asanton, CA 94588-9101 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED <br /> [MANT] INSURERA:Neth6rlands Ins Co The 24171 <br /> Cal West Concrete Cutting Inc. INSURERB:Zurich American Ins Cc 16535 <br /> 1153 Vanderbuilt Circle <br /> INSURER C: <br /> Manteca, CA 95337 INSURER D: <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 /> I1-.TR TYE90FINSURANCE N5R bD' POLICYNUMSER POLICY EFFECTIVE POLtCYEXPIRATIOMDDfy4NOAT LIMITS _ <br /> B X GENERAL LIABILITY GL0427763000 11/01/06 11/01/07 EACH OCCURRENCE $1,000,000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES Faoccurence S 300,000 <br /> CLAIMS MADE Fx--1 OCCUR MED EXP(Any one person) $10,000 <br /> X HI/PD DED: 5,000 PERSONAL&ADV INJU RY $1,000,000 <br /> X OCP GENERAL AGGREGATE $2,000,000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $2,000,000 <br /> POLICYF7..PRO- LOC <br /> A AUTOMOBILE LIABILITY BA8082829 11/01/06 11/01/07 <br /> COMBINED SINGLE LIMET <br /> X ANY AUTO (Eaaccicienl) $1.000,000 <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> X HIREDAUTOS <br /> BODILY INJURY <br /> X NON•OWNEDAUTOS (Per accident) $ <br /> X LGTX-DED:2.5KComp/Col1 <br /> PROPERTYDAMAGE <br /> X OTR DED:1KComp/Coli (Peraccidenl) $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO <br /> OTHER THAN FA ACC $ <br /> AUTOONLY: AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR F7 CLAIMS MADE AGGREGATE $ 1 <br /> $ <br /> DEDUCTIBLE <br /> RETENTION S - $ <br /> WORKERS COMPENSATIDNAND WCSTATU- OTH- <br /> EMPLOYERS'LIABILITY - <br /> ANY PROPRf£TOR/PARTNERIEXECUTIVE <br /> E.L.EACH ACCIDENT 5 <br /> OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ <br /> II yes,describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT is <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> -RE: All California Operations as required by written contract. ; <br /> ADDITIONAL INSURED (per attached) : i <br /> Geological Technics, Inc. <br /> i <br /> CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment of Premium <br /> REP: All CA Ops SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> G—logical Technics, Inc. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> (k NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> 1301 7th Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> Modesto, CA 95354 AUTHORIZED REPRESENTATIVE I <br /> USA �jt7,1 <br /> ACORD 25(2001108)judfen m ACORD CORPORATION 1588 <br /> 7263359 <br />
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