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WP0039164
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039164
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Entry Properties
Last modified
5/21/2019 4:15:03 PM
Creation date
5/20/2019 4:00:55 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039164
PE
4372
STREET_NUMBER
1422
Direction
W
STREET_NAME
COLONY
STREET_TYPE
RD
City
RIPON
Zip
95366-
APN
26158006
ENTERED_DATE
1/7/2019 12:00:00 AM
SITE_LOCATION
1422 W COLONY RD
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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TWINLAB-01 CBOYD <br /> ACORO ( DIYY <br /> 111 0607/2018 <br /> OF LIABILITY INSURANCE DATE YY) <br /> os/o7/MMIDD1YY <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 AICO,NWo,Ext: 559 432-0222 (A/C,No:(559 431-7941 <br /> P.O.Box 5479 IL <br /> Fresno,CA 93755-5479 <br /> INSURERS AFFORDING COVERAGE NAIC M <br /> INSURER A:Nationwide Mutual Insurance Company 23787 <br /> INSURED INSURER B:State Compensation Insurance Fund 35076 <br /> Moore Twining Associates,Inc. INSURERC: <br /> P.O.Box 1472 INSURERD: <br /> Fresno,CA 93716 <br /> -INSURERE: <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 OFINSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> T <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE <br /> CLAIMS-MADE F—]OCCURDAMAGE TO RENTED <br /> MED EXP An one person) <br /> PERSONAL&ADV INJURY $ <br /> GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE <br /> POLICY —]j�T LOC PRODUCTS-COMP/OP AGG <br /> OTHER: <br /> A AUTOMOBILE LIABILITY COMBI tlED SINGLE LIMIT 1000,000 <br /> (Ea accent) <br /> X ANY AUTO ACP3017734643 06/14/2018 06/14/2019 BODILY INJURY Per arson <br /> OWNED SCHEDULED <br /> AURTEO�S ONLY AUUTNOpSyy �p BODILY INJURY Per accident <br /> AUTOS ONLY AUTOS ONNLY Pe0accj AMAGE <br /> UMBRELLA LIAB HOCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DED RETENTIONS <br /> B WORKERS COMPENSATION X STATUTE ER <br /> PER OTH- <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTNE Y/N 9230422201 8 05/01/2018 05/01/2019 E.L.EACH ACCIDENT 1'000'000 <br /> MFICER/MEMgER EXCLUDED? N/A <br /> andatoryIn NH) E.L.DISEASE-EA EMPLOYE 1'000'000 <br /> It es,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> FOR INFO ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <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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