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WP0039867
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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12 (STATE ROUTE 12)
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13550
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039867
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Entry Properties
Last modified
11/19/2024 3:48:24 PM
Creation date
9/6/2019 3:30:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039867
PE
4370
STREET_NUMBER
13550
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95242-
APN
05502002
ENTERED_DATE
7/25/2019 12:00:00 AM
SITE_LOCATION
13550 W HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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DREW&HE-01 J CHOE <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) <br /> 7/1112019 <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 SUI3ROGATION 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 /> CONTACT <br /> PRODUCER AME:.___._.. <br /> Foster 8:Parker Insurance PHONE FAX Np; 659 674-5231 <br /> 1643 N. Schnoor Street,Suite 103 (AIC,No Exq:(559)674-8536 _ <br /> Madera,CA 93637 QRF�' — <br /> INSURER(S)AFPORO!NG COVERAGE_ NAIC it <br /> INSURERA:Atainftecla_yt Insurance Co. <br /> INSURED INSURERS:_._.._ <br /> Drew&Hefner Water Well Drilling INSURER C: <br /> 26452 Avenue 17 1/2 1NSURERD: _ <br /> Madera,CA 93638 INSURERS: <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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERT FICATE 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 TYPE OF INSURANCE ADDLjSUBR,wVDI POLICY NUMBER POLICY EFFMMIDDIYYM <br /> POLICY EXP LINTS <br /> A X !COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE fM <br /> 1,000,000 <br /> DAMA-I CLAIMS-MADE X OCCUR ICIP384110 3!2412019 3/24/2020 FREM ETORENTED 100,000 <br /> REMISES(Ea.gcW_- 8_ <br /> MED EXPone person 5'000 <br /> PERSONAL&ADV INJURY 1000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAP_QREqATE ____ 2,000'000 <br /> POLICY❑X j r=i LOC PROpyCTS-COMP/OP AGG S 2,000,000 <br /> OTHER: <br /> I COMBINED SINGLE LIMIT S <br /> AUTOMOBILELIABWTY I aaccideilU _— <br /> ANY AUTO I BODILY INJURY(Per person) _ <br /> OVVNFUTOS ONLY Sr-,HHALTOSULED BODILY INJURYIPer accideMAGE nt <br /> - - E or aacciderlt _- S <br /> AUTOS ONLY AU O ONLOY <br /> UMBRELLALWB OCCUR EACH OCCURRENCE 9 _ <br /> .�EXCESSLIAB..._l CLAIMS-MADE AGGREGATE S -..--- <br /> OED-RETENTIONS <br /> P R <br /> WORKERS COMPENSATION .. <br /> AND EMPLOYERS'LIABILITY Y I N <br /> AM'PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT 8 _ <br /> NIA <br /> MEn BER EXCLUDED? <br /> Aa CERI <br /> EL.DISEASE-EA EMPLOYEE S <br /> ndatory If yyrrs,describe under L DIS -POLICY LIMB <br /> DE:3CRIPTION OF OPERATIONS below <br /> III <br /> I <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) <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 /> For Insured Use ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORED REPRESENTATIVE <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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