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SU0011908
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2600 - Land Use Program
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PA-1800150
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SU0011908
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Entry Properties
Last modified
5/7/2020 11:35:31 AM
Creation date
9/6/2019 10:16:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0011908
PE
2666
FACILITY_NAME
PA-1800150
STREET_NUMBER
800
Direction
W
STREET_NAME
MOSSDALE
STREET_TYPE
RD
City
LATHROP
Zip
95330-
APN
23903008, 23903014
ENTERED_DATE
8/22/2018 12:00:00 AM
SITE_LOCATION
800 W MOSSDALE RD
RECEIVED_DATE
8/20/2018 12:00:00 AM
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MOSSDALE\800\PA-1800150\SU0011908\APPL.PDF \MIGRATIONS\M\MOSSDALE\800\PA-1800150\SU0011908\EH COND.PDF \MIGRATIONS\M\MOSSDALE\800\PA-1800150\SU0011908\EH PERM.PDF \MIGRATIONS\M\MOSSDALE\800\PA-1800150\SU0011908\DC MEMO.PDF
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EHD - Public
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AC"R" CERTIFICATE OF LIABILITY INSURANCE DATEIMh1,001YYYY) <br /> li,. ' 1 4!2412015 <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the forms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> Alliant Insurance Services Inc pNAME Bethany Kaiser <br /> HO <br /> 7525 N Cedar Ave Ste 101 L_C.Ne.E559 437 3380 Ac. <br /> � .; , 559 437 3385 <br /> E-MAIFresno CA 93720 ADDRESS, �bkalser aliiant.comnDRE __� _._._... <br /> lNSURE5 AFFOROMGCOY£RAGENAAC• <br /> --, . <br /> INSURER n:Commerce and Industry Insurance Com 15410 <br /> INSURED INSURER 9: <br /> Woodward Drilling Company, Inc INsuRERc: <br /> P O Box 336 <br /> Rio Vista CA 94571INsuRE�tD: — v <br /> INSURER E: _._._._..�___._....��,_�,.. <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 173396202 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 W17H 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 TERNIS <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br /> 74IHI�'SGBR`._. P'OLIeY EXP.. <br /> LTR TYPE OF INSURANCE iIVSD wvD POUCYNUMBER t MM'OD/YYYY MMIDor(YYY LtIWTS <br /> COMMERCIAL GENERAL LIABILITY N 1 EACH OCCURRENCE S <br /> _— <br /> CLAIM <br /> _ <br /> S•MA( i OCCUR <br /> MED EXP tAny ar+e penin) S _ <br /> PERSONAL b ADV INJURY ` S <br /> GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S <br /> I <br /> POLICY LOC PRD- PRODUCTS-COMP/OP GG S <br /> L__.�JECT A <br /> ^� <br /> OTHER .._. �...._" _ <br /> S <br /> AUTOMOBILE LIABIU TY N t£e itudant) ... S _ <br /> .. _-. .. <br /> -�;Y AUTO BODILY INJURY(Per person S <br /> ALL OWNED .. .�.___ <br /> ;SCHEDULED <br /> A:J705 AUTOS 8001LY INJURY!Par atudonty�S <br /> HIRED AUTOS <br /> AUTOS <br /> " 't <br /> S <br /> U"RFLLA UAB OCCUR N EACH OCCURRENCE S <br /> EXCESS UAB CLAIMS-MADE AGGREGATE S <br /> D I I RETENTIONS - Is ._ <br /> WORKERSCOMPENSATION ,27t62?: 11801 5 X R H. <br /> AND EMPLOYERS'LiABIUTY STATUTE �, ER <br /> YIN /0/112014 /0 <br /> ANY PROPRIETOR PARTNERiEXECUTIVE p. <br /> OFFICERVEMSER EXCLUDED' I T NrAi # E.L EACH ACCIDENTS1.000.000 _ <br /> (Mandatory in NH! E L DISEASE-EA EMPLOYEE $1,000,000 <br /> R as descnbc antler <br /> SCRIPTION OF OPERATIONS De>ow E.l DISEASE-POLICY LIMIT 51.000.000 <br /> DE <br /> I <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Addn+onal Rcmaris Schedule,may be aftached if more Space is regwmdi <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Brown Sand Inc ACCORDANCE WITH THE POLICY PROVISIONS <br /> P.O. Box 1429 <br /> Lathrop CA 95330 AUTHORIZED REPRESENTATIVE <br /> / <br /> � 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name arid logo are registered marks of ACORD <br />
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