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WP0038718
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4200/4300 - Liquid Waste/Water Well Permits
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WP0038718
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Entry Properties
Last modified
4/17/2019 11:36:01 AM
Creation date
4/17/2019 11:03:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0038718
PE
4372
STREET_NUMBER
25701
Direction
S
STREET_NAME
CORPORATE
STREET_TYPE
CT
City
TRACY
Zip
95377-
APN
20911051
ENTERED_DATE
8/29/2018 12:00:00 AM
SITE_LOCATION
25701 S CORPORATE CT
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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TWINLAB-01 <br />CBOYD <br />,acoRO CERTIFICATE OF LIABILITY INSURANCE <br />�--� <br />DATE 04/30/2018 Y) <br />04/30/2018 <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(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER License # OE02096 <br />COME:NTACT <br />NA <br />PHONE <br />No, Ext): (559) 432-0222 n/c , No): (559) 431-7941 <br />DiBuduo & DeFendis Insurance Brokers, LLC <br />P.O. Box 5479 <br />Fresno, CA 93755-5479 <br />Fresno, <br />E_ <br />S S: <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A: Nationwide Mutual Insurance Company 23787 <br />DAMAGETO RENTEDPREMISS (Ea occurrence) $ <br />INSURED <br />INSURER B: State Compensation Insurance Fund 35076 <br />INSURER C: <br />Moore Twining Associates, Inc. <br />INSURER D: <br />P.O. Box 1472 <br />Fresno, CA 93716 <br />INSURER E <br />INSURER F: <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />WN p <br />X AUTOS ONLY X AUOTOS O�Y <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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />D <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />I <br />POLICY EXP <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 7 OCCUR <br />EACH OCCURRENCE $ <br />DAMAGETO RENTEDPREMISS (Ea occurrence) $ <br />MED EXP (Any one arson $ <br />PERSONAL & ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ jER4 ❑LOC <br />OTHER: <br />GENERAL AGGREGATE $ <br />PRODUCTS -COMP/OP AGG $ <br />A <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />WN p <br />X AUTOS ONLY X AUOTOS O�Y <br />ACP3017734643 <br />06/14/2017 <br />06/14/2018 <br />COMaBINED SINGLE LIMIT nt)$ 1,000,000 <br />(EaX <br />BODILY INJURY Per arson $ <br />BODILY INJURY Per accident $ <br />PerOP.ER'ent AMAGE <br />UMBRELLA UAB <br />EXCESS LIAR <br />HCLAIMS-MADE <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE <br />DED I I RETENTION $ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />FICER/M MBER EXCLUDED? ❑ <br />andatory in NH) <br />If es, describe under <br />DESCRIPTION OF OPERATIONS below <br />N I A <br />92304222018 <br />05/01/2018 <br />05/01/2019 <br />X PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE 1,000,000 <br />E.L. DISEASE -POLICY LIMIT 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />For Information Only <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 />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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