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COMPLIANCE INFO 2012 - 2018
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231211
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COMPLIANCE INFO 2012 - 2018
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Entry Properties
Last modified
5/15/2019 5:10:41 PM
Creation date
5/15/2019 2:24:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2012 - 2018
RECORD_ID
PR0231211
PE
2371
FACILITY_ID
FA0002409
FACILITY_NAME
SAFEWAY FUEL CENTER #2707
STREET_NUMBER
6425
Direction
N
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
CURRENT_STATUS
01
SITE_LOCATION
6425 N PACIFIC AVE
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 5/10/2018 <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 <br /> CNA. <br /> Megan Montano <br /> Woodruff-Sawyer&Co. PHONE FAX <br /> 50 California Street, Floor 12 (AIC. o E10:415-391-2141 A/c No):415-989-9923 <br /> San Francisco CA 94111 ADDRESS: mmontano wsandco.com <br /> INSURERS)AFFORDING COVERAGE NAIC# <br /> INSURERA:Hartford Insurance Company of the Midwest 37478 <br /> INSURED ARMERNORMA INSURER B:Western World Insurance Company 13196 <br /> Armer/Norman &Associates, Inc. <br /> 2600 Williams Street INSURER C:Trumbull Insurance Company 27120 <br /> San Leandro CA 94577 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1060489105 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 ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE J=WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> B X COMMERCIAL GENERAL LIABILITY EVP100097200 4/29/2018 4/29/2019 EACH OCCURRENCE $1,000,000 <br /> CLAIMS-MADE El OCCUR DAMAGE S I RENTED <br /> PREMISES Ea occurrence $50,000 <br /> MED EXP(Any one person) $10,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY PECOT- [:] LOC PRODUCTS-COMP/OP AGG $2,000,000 <br /> OTHER: $ <br /> C AUTOMOBILE LIABILITY 57UEAFM4579 4/29/2016 4/29/2019 COMBINED SINGLE LIMIT $1,000,000 <br /> Ea accident <br /> IxANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED LX <br /> NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> B UMBRELLA LIAB X OCCUR EVX100097300 4/29/2018 4/29/2019 EACH OCCURRENCE $2,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 <br /> DED RETENTION$ $ <br /> A WORKERS COMPENSATION 57WEART6620 4/29/2018 4/29/2019 X PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBEREXCLUDED? r N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Evidence of Insurance only. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD AfffOF THE-ABOVE—DESCRIBED POLICIES-BE CANCELLED-BEFORE— <br /> THE <br /> ANCELLED-BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Armer/Norman &Associates <br /> Evidence AUTHORIZED REPRESENTATIVE <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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