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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0508012
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Last modified
7/3/2019 3:13:21 PM
Creation date
7/3/2019 11:55:12 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0508012
PE
2960
FACILITY_ID
FA0007884
FACILITY_NAME
SURLAND HOMES
STREET_NUMBER
2532
STREET_NAME
DORSET
STREET_TYPE
LN
City
TRACY
Zip
95376
APN
23830005
CURRENT_STATUS
01
SITE_LOCATION
2532 DORSET LN
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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CONTRACTOR'S ENDORSEMNT <br /> Folder No.02153-03 <br /> A. As a condition to entering upon Licensor's right-of-way to perform work pursuant to this <br /> Agreement, Licensee's contractor(Fill ie): <br /> Sr- itvice- rp!-(-ata-ns I�f�:nccF' nct � Cc+r��ttu�t'vv+ <br /> CA <br /> (hereinafter"Contractor")agrees to comply with all the terms and provisions of this Agreement relating <br /> to the work to be performed and the insurance requirements set forth in Exhibit C. <br /> B. Before the Contractor commences any work, the Contractor will pay the Licensor a <br /> nonrefundable payment of$500 upon execution and return of this Contractor's Endorsement, and m,111 <br /> provide the Licensor with a certificate issued by its insurance carrier providing the insurance coverage <br /> required pursuant to Exhibit C in a policy which contains the following type endorsement: <br /> UNION PACIFIC RAILROAD COMPANY is named as an additional insured <br /> with respect to all liabilities arising out of Insured's performance of work on behalf of the <br /> Licensee. <br /> All insurance correspondence shall be directed to: Toa E.Devish -Folder No. 02153.03, Union Pacific <br /> Railroad Company, 1400 Douglas Street STOP 1690,Omaha,Nebraska 68179-1690. <br /> (Please print Contractor's NN c above)` <br /> Title: Dlv M <br />
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