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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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Alk <br />ACORD CERTIFICATE OF LIABILITY INSURA E OP ID P DATE(MM/DD/YYYY) <br />WALTON1 09/21/06 <br />rt,RODUCER <br />InterWest Insurance Services <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Capitol Division <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P.O. Box 255188 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Sacramento CA 95865-5188 <br />POLI <br />DATE MMIDDlW <br />LIMITS <br />Phone: 916-4B8-3100 Fax:916-488-3492 <br />INSURERS AFFORDING COVERAGE <br />NAIC0 <br />INSURED <br />INSURER A: State Comp Ins Fund (CA) <br />EACH OCCURRENCE 35,000,000 <br />INSURER B Evanston Insurance Co. <br />INSURER C: NaLonwide Mutual Ins Company <br />Walton Engineering, Inc. <br />P.O. Box 1025 <br />West Sacramento CA 95691 <br />INSURER D: United National Ins. Co. <br />INSURER E: The Hartford 22357 <br />PREMISES Ea occurance} $50,000 <br />COVERAGES <br />T'HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE DEEN REDUCED BY PAID CLAIMS. <br />LTR <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />P LI YEFFECTIVE <br />DATE MWDDIYY <br />POLI <br />DATE MMIDDlW <br />LIMITS <br />ALrTHqPIZED REP TA IVE <br />GENERAL LIABILITY <br />EACH OCCURRENCE 35,000,000 <br />B <br />X COMMERCIAL GENERAL LIABILITY <br />06PKGO1395 <br />03/06/061 <br />03/06/07 <br />PREMISES Ea occurance} $50,000 <br />CLAIMS MADE OCCUR <br />MED EXP (Any one Person) $5,000 <br />PERSONAL BADVINJURY 31 000 000 <br />X $5,000 Ded <br />GENERAL AGGREGATE :55,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS -COMPIOPAGG S5,000,000 <br />POLICY PRO- <br />JECT f7 LOC <br />I <br />Emp Ben. 1,000,000 <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $1000 000 000 <br />C <br />X <br />ANY AUTO <br />ACP7802143676 <br />03/06/06 <br />03/06/07 <br />(Fa accident) i r <br />BOOLYINJURY $ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />X <br />HIREDAUTOS <br />BODILY INJURY $ <br />X <br />NON -OWNED AUTOS <br />(Par accidant) <br />DExcess <br />X <br />Auto <br />Fca�0003233 <br />01/03/06 <br />03/06/07 <br />PROPERTYDAMAGE <br />(Peraccident) b <br />$4,000,000 <br />GARAGE <br />LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />ANY AUTO <br />OTHER THAN EA ACC $ <br />AUTO ONLY: AGG $ <br />EXCESSIUMERELLALULBUJTY <br />EACH OCCURRENCE $ <br />OCCUR FICLAIMS MADE <br />AGGREGATE $ <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />X I TORYLIMITS I I ER <br />A <br />EMPLOYERS' LIABILITY <br />713000492706 <br />10/01/06 <br />10/01/07 <br />EL EACH ACCIDENT $1,000,000 <br />ANY PROPRIETOR/PARTNEWEXECUTIVE <br />E.LDISEASE- EAEMPLOYEE $1 000 000 <br />OFFICERIMEMBEREXCLUDED? <br />H yes, describe under <br />SPECIAL PROVISIONS below <br />E.L DISEASE -POLICY LIMIT $ 1, 000,0()0 <br />OTHER <br />B <br />Pollution/E&O <br />06PKGO1395 <br />03/06/06 <br />03/06/07 <br />Poll/E&O $5,000,000 <br />E <br />Installation Fltr <br />57UUNAE4051 <br />03/06/06 <br />03/06/07 <br />Inst Fltr $1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Pollution Ded $25,000; Professional Liability Ded $50,000 <br />D)Installation Floater Policy #57UUNUN0523; Exp 12/15/06; Limit $1,000,000 <br />Any Location; $250,000 In Transit Deductible $2,500 <br />*10 Day notice of cancellation applies for non-payment of premium. (Replaces <br />all previously issued certificates) <br />CERTIFICATE HOLDER CANCELLATION <br />TO WHOM <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <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 50 SHALL <br />To Whom It May Concern <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />ALrTHqPIZED REP TA IVE <br />ACORD 25 (2001108) ©ACORD CORPORATION 1988 <br />
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