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WP0039451
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039451
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Entry Properties
Last modified
3/24/2022 3:04:02 PM
Creation date
7/31/2019 11:49:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039451
PE
4371
STREET_NUMBER
5935
STREET_NAME
ALEXANDRIA
STREET_TYPE
PL
City
STOCKTON
Zip
95206-
APN
11206067
ENTERED_DATE
3/14/2019 12:00:00 AM
SITE_LOCATION
5935 ALEXANDRIA PL
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2019
Tags
EHD - Public
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FARWCOR-01 EBRITO <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) <br /> 09/11/2018 <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#0757776 CONTACT Eunice Lee <br /> NAME: <br /> HUB International Insurance Services Inc. PHONE 949 623-1045 FAX <br /> 4695 MacArthur Court,Suite 600 (A/C,No,ext):( ) (A/c,No):(951)231-2572 <br /> Newport Beach,CA 92660 EdoRIEs :cal.cpu@hubinternational.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURERA:AIG Specialty Insurance Company 26883 <br /> INSURED INSURERB:The First Liberty Insurance Corporation 33588 <br /> Farwest Corrosion Control Company INSURER c:Liberty Mutual Fire Insurance Company 23035 <br /> 12029 Regentview Avenue INSURER D: <br /> Downey,CA 90241-3215 <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 ITRTYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE FX] OCCUR EG16542189 08/01/2018 08/01/2019 DAMAGE ToRaEONccTED $ 300,000 <br /> MED EXP(Any oneperson) $ 25,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY JE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY COMBINEDtSINGLE LIMIT $ 1,000,000 <br /> (Ea accideX ANY AUTO AS6Z61036697208 08/01/2018 08/01/2019 BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS E BODILY INJURY Per accident $ <br /> X AURTOS ONLY X AUTOS ONL� PPerr acEcandent AMAGE $ <br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 <br /> X EXCESS LIAB CLAIMS-MADE EGU16542191 08/01/2018 08/01/2019 AGGREGATE $ 10,000,000 <br /> DED I X I RETENTION$ 0 $ <br /> C WORKERS COMPENSATION X PERTUTE OTH- <br /> AND EMPLOYERS'LIABILITY Y/N WC2Z61036697198 08/04/2018 08/04/2019 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? [_—] N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,desc be 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 /> RE:County of San Joaquin. <br /> For Information Purposes Only. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> County Of San Joaquin THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Y q ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Environmental Health Department <br /> 1868 East Hazelton Ave. <br /> Stockton,CA 95205 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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