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WP0038926
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4200/4300 - Liquid Waste/Water Well Permits
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WP0038926
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Entry Properties
Last modified
5/21/2019 8:59:32 AM
Creation date
5/20/2019 3:47:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0038926
PE
4372
STREET_NUMBER
751
STREET_NAME
BROOKSIDE
STREET_TYPE
RD
City
STOCKTON
Zip
95211-
APN
11025019
ENTERED_DATE
10/23/2018 12:00:00 AM
SITE_LOCATION
751 BROOKSIDE RD
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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SALEENG-01 MMAZZA <br /> .ACORO` CERTIFICATE OF LIABILITY INSURANCE <br /> DATE 12/0 1 12 0 1 YY) <br /> �-� 12/01/2017 <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 CONTACT <br /> NAME: <br /> DiBuduo&DeFendis Insurance Brokers,LLC PHONE, <br /> HONE,Ext):(559)432-0222 FAX,No):(559)431-7941 <br /> P.O.Box 5479 <br /> Fresno,CA 93755-5479 ADORE S S: <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> _ INSURER A:Valley Forge Insurance Co 20508 <br /> INSURED INSURER B:Continental Insurance Company 35289 <br /> Salem Engineering Group,Inc. INSURER C:American Casualty Company of Reading PA 20427 <br /> 4729 W.Jacquelyn Ave. INSURER D:Continental Casualty Company 20443 <br /> Fresno,CA 93722 <br /> INSURER E <br /> INSURER F: <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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2'000,000 <br /> CLAIMS-MADE FX OCCUR X 6015893246 12/01/2017 12/01/2018 DAMAGE TO RENTED)n <br /> ENTEan $ 300,000 <br /> MED EXP(Any oneperson) $ 15,000 <br /> PERSONAL&ADV INJURY $ 2'000'000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4'000,000 <br /> POLICY IXI jpeT F�LOC PRODUCTS-COMP/OP AGG $ 4,000,000 <br /> OTHER: <br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident)X ANY AUTO 6045473729 12/01/2017 12/01/2018 BODILY INJURY Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> ppNN PerOacEclRd Y DAMAGE $ <br /> AU SONLY AUTOONLDY <br /> B X UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 5'000'000 <br /> EXCESS LIAB CLAIMS-MADE 6015893232 12/01/2017 12/01/2018 AGGREGATE $ 5'000,000 <br /> DED I X I RETENTION$ 10,000 <br /> C WORKERS COMPENSATION X IPER OTH- <br /> ANDEMPLOYERS'LIABILITY STATUTE ER <br /> 6020581635 12/01/2017 12/01/2018 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ N/A E.L.EACH ACCIDENT $ <br /> OOFF"ggM MBER EXCLUDED? 1,000,000 <br /> (Mande ry n I E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> D Prof./Pollution Liab AEH591895527 12/0112017 12/01/2018 Each Claim 2,000,000 <br /> D Prof./Pollution Liab AEH591895527 12/01/2017 12/01/2018 Aggregate 4,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101,Additional Remarks Schedule,ma be attached if more space is required) <br /> Certificate Holder is named Additional Insured(including Completed Operations andyPrimary Non-Contributory Wording)as respects General Liability per <br /> attached blanket policy form CNA75079XX(1-15). <br /> Professional/Pollution Liability deductible per claim-$35,000 <br /> Actual Certificate to be issued upon request <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> SAMPLE CERTIFICATE** THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> I <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
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