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COMPLIANCE INFO 2005 - 2009
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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PR0231435
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COMPLIANCE INFO 2005 - 2009
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Entry Properties
Last modified
8/7/2019 3:13:32 AM
Creation date
8/6/2019 2:20:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2005 - 2009
RECORD_ID
PR0231435
PE
2361
FACILITY_ID
FA0000916
FACILITY_NAME
7-ELEVEN INC #19976
STREET_NUMBER
1399
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21633034
CURRENT_STATUS
01
SITE_LOCATION
1399 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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KBlackwell
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EHD - Public
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OP ID $ DATE (MM/DD/yYYY) <br />ArVoRD CERTIFI-CAOF LIABILITY INSURA WALTO-2 03/06/07 <br />PRODUCER THIS CERTIFICATE IS I UED ASA MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />TLB Insurance Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />10 00 Broadway Suite 289 <br />Oakland CA 94607-4090 <br />Phone: 510-628-9100 Fax:510-628-9115 INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />Evanston Insurance Co. <br />B: Redland Insurance Company <br />IAC. <br />LINSURERA: <br />C: state compeasation insurance <br />Walton Engineering, <br />P.O. Box 1025 <br />D: Hartford Insurance Co <br />34690 <br />West Sacramento CA 95691 <br />R E: <br />COVERAGES <br />LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />OR <br />THE POLICIES OF INSURANCE <br />OF ANY CONTRACT OR OTHER DOCUMENT <br />WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED <br />ANY REQUIREMENT, TERM OR CONDITION <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT <br />TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />MAY PERTAIN, <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />POLICY NUMBER <br />POLICY EFFE TIVE POLICY EXPIRATION LIMITS <br />DATE MM/DD/YY DATE MM/DD/YY <br />LTR NSR TYPE OF INSURANCE <br />EACH OCCURRENCE 1$1,0o0,000 <br />GENERAL LIABILITY <br />07PKGO1395 <br />03/06/07 03/06/08 <br />350,000 <br />A X COMMERCIAL GENERAL LIABILITY <br />MEDEXPREMISES(Eaonepersonnre) <br />MED EXP (Any one person) <br />S 5,000 <br />CLAIMS MADE � OCCUR <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />X $5,000 Ded <br />GENERAL AGGREGATE <br />s2,000,000 <br />PRODUCTS - COMP/OP AGG <br />$ 2, 0 00,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />Fmp Ben . <br />1,000,000 <br />PRO- LOC <br />POLICY IECT <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 1,0001000 <br />8001121446 <br />03/06/07 03/06/08 <br />B X ANY AUTO <br />ALL OWNED AUTOS <br />BODILY INJURY <br />(Per person) <br />$ <br />SCHEDULED AUTOS <br />X HIRED AUTOS <br />BODILY INJURY <br />(Per accident) <br />$ <br />X NON OWNED AUTOS <br />PROPERTY DAMAGE <br />$ <br />(Per accident) <br />AUTO ONLY - EA ACCIDENT <br />$ <br />GARAGE LIABILITY <br />EA ACC <br />$ <br />OTHER THAN <br />ANY AUTO <br />AUTO ONLY: AGG <br />$ <br />EACH OCCURRENCE <br />S 4,000,000 <br />EXCESS/UMBRELLA LIABILITY <br />OCCUR CLAIMS MADE 07EFX00007 <br />03/06/07 03/06/08 AGGREGATE <br />ls4,000,000 <br />A <br />$ <br />DEDUCTIBLE <br />RETENTION $ -ER H - <br />WORKERS COMPENSATION AND X TORY LIMITS <br />C EMPLOYERS' LIABILITY 713000492706 10/01/06 10/01/07 E.L. EACH ACCIDENT $ 1,000,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ 1 , 0 0 0 , 0 0 0 <br />OFFICER/MEMBER EXCLUDED? <br />If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1 , 0 0 0 , 0 0 0 <br />SPECIAL PROVISIONS below <br />OTHER <br />A Pollution/E&O 07PKGO1395 03/06/07 03/06/08 <br />D Installation Fltr 57MSIZ6050 03/06/07 03/06/08 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. <br />Poll/E&O $1,000,000 <br />Inst Fltr $1,000,000 <br />CERTIFICATE HOLDER CANCELLATION <br />TOWHOMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />To Whom It May Concern IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />Dennis Cote' <br />©ACORD CORPORATION 19E <br />ACORD 25 (2001108) <br />
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