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WP0039438
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039438
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Entry Properties
Last modified
9/9/2019 8:31:45 AM
Creation date
9/6/2019 3:19:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039438
PE
4371
STREET_NUMBER
0
STREET_NAME
EIGHTH
STREET_TYPE
ST
City
STOCKTON
Zip
95206-
APN
16307025
ENTERED_DATE
3/14/2019 12:00:00 AM
SITE_LOCATION
0 EIGHTH ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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FARWCOR-01 EBRITO <br /> ACORN' CERTIFICATE OF LIABILITY INSURANCE <br /> FDATE 09/11/2018 Y) <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 No,Ext):(949)623-1045 j,vc,No):(951)231-2572 <br /> 4695 MacArthur Court,Suite 600 <br /> Newport Beach,CA 92660 A oRlEss:cal.cpu@hubinternational.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURERA:AIG Specialty Insurance Company 26883 <br /> INSURED INSURER B:The First Liberty Insurance Corporation 33588 <br /> Farwest Corrosion Control Company INSURER C:LibertV 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 CONTRACTOR 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 ryPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTRA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000'000 <br /> CLAIMS-MADE F_X]OCCUR EG16542189 08/01/2018 08/01/2019 DAMAGE TO RENTED 300,000 <br /> E ES a occurrence) $ <br /> MED EXP(Any oneperson) $ 25,000 <br /> PERSONAL&ADV INJURY 1'000'000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY COMBI tlEeD SINGLE LIMIT $ 1,000,000 <br /> (Ea accIx <br /> ANY AUTO AS6Z61036697208 08/01/2018 08/01/2019 BODILY INJURY Per erson $ <br /> OWNED SCHEDULED <br /> AURRTOS ONLY AUUTNOS BOO�DILY INJURY Per accident $ <br /> AUT�S ONLY X AUTO ONLY DAMAGE <br /> 'TO <br /> $ <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 X RETENTION$ 0 $ <br /> C WORKERS COMPENSATION X PER OTH- <br /> ANDEMPLOYERS'LIABILITY <br /> ISTATUTE ER <br /> YWC2Z61036697198 08/04/2018 08/04/2019 1,000,000 <br /> ANY OFFICERIM <br /> OPRIETOER/EXCLUDED?ECUTIVE ❑ NIA E.L.EACH ACCIDENT <br /> (Mandatoryin NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/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 /> Count 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 /> oouj��_ <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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