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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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ACOR[7 CERTIFICATE OF LIABILITY INSURANCE DATE IMM'DD YYYY) <br /> I 4i2412015 <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 terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confor rights to the <br /> cortificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Betha�Kaiser <br /> Alhant Insurance Services Inc ----- <br /> PHONE 559.437 3380 FAX 559 437.3385 <br /> 1525 N Cedar Avenue (A(C_No.Eatl _ Uvc.xol.___ <br /> Suite 1C1 E-MAIL bkalser alliant corn <br /> Fresno CA 93720 INSURER(S)AFFORDING COVERAGE <br /> INsuagn ;National Specialty Insurance Com�a1308 <br /> Co <br /> INSURED INSURER 0 <br /> LNoodward Drilling Company Inc INstradec: <br /> P O Box 336 <br /> Rio Vista CA 94571 INSURER D: _ <br /> INSURER B: _ <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 126740803 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 /> MA A_..—_._.__.__ _ .___ _- _ -'ADOL-suss _... _ _ <br /> R TYPE OF INSURANCE INGD'V/VD POLICY NUMBER � MMM/ODtYYVY LIMITS - - <br /> A X COMMERCIAL GENERALLIABILtTY MDFC1"35355 0/2012014 !2012015 EACH OCCURRENCE i 52,000,000 <br /> CLAIMS-MADE X OCCUR <br /> S A ItSRENIED — <br /> �� d PR R! Eaoccurrence SS00000 <br /> �__.. <br /> i MED EXP(Arty one p mon) S5.000 <br /> PERSONAL S AOV INJURY $2,000.000 <br /> GEN`L AGGREGATE LIMIT APPLIES PER ? GENERAL AGGREGATE 54.000,000 <br /> X POLICY ? _. <br /> e LOC PRODUCTS-COMPIOP AGG 54.000.000 <br /> DT-4ER 'S <br /> A ;AUTOMOBILE LIABILITY GIF•-'.55 012014 8120=15 COMBINED SINGLE Ea 1 $2.000.000 <br /> X ANY AUTO BODILY INJURY(Per person) S <br /> AUL OWNED LED BODILY INJURY(Pet awdpy)i11Y S .._.._ .._. <br /> t1tRE0 AUT05 =D Per acndent —__. 1 S <br /> __..._..._1_ <br /> X UMBRELLA u a y <br /> INFFOISS365 P12012014 120!2016 � EACH OCCURRENCE <br /> p. _ <br /> EXCESS LIAB 1 CLAJMS-MADEi 3 AGGREGATE _ $5,000.000 _.. <br /> Xi <br /> RETENT 14N S 10.000 <br /> V <br /> WORKERS COMPENSATION ( R 3 OTH <br /> AND EMPLOYERS'LIABILITY YIN, <br /> __UAS�. ER.ANY PROPRETORIPARTNEWEXECUTIVE � i E L EACH ACCIDENT 5 <br /> -�rFICERWEMBER EXCLUDED') R/A(i E I .,_. >, ._..._------- .__._.__. <br /> (Mandatory in NN) E L DISEASE„EA EMPLOv C 5 <br /> '!1@5 025CnD@ WK!®r E L DSEASE•POLI:Y. 1e <br /> n- SCRIPT*NOFOPERATIONSWOW <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 7 VeMCLES (ACORO 101.Additl onal Rune rMa Sa hedule,may be attach+d if more space is«quired) <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 REPRESENTATIV17 <br /> (K)1988-2014 ACORD CORPORATION All rights reserved, <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />
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