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WP0039868
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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WP0039868
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Entry Properties
Last modified
11/19/2024 3:48:24 PM
Creation date
9/6/2019 3:31:53 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039868
PE
4380
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 JSCHOE <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <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 o?rtificate does not confer rights to the certificate holder in lieu of such endorsemen s). <br /> :CONTACT <br /> PRODUCER <br /> Foster 8:Parker Insurance <br /> ANo,Ext):(559)674$536 --_ (A C,No):(559)674-5231 <br /> 1643 N.Schnoor Street,Suite 103 INC,-- - - — <br /> Madera,CA 93637 : <br /> INSURERS)AFFORDING COVERAGE <br /> wsuRERA:Atain SpecaftInsurance Co. <br /> INSURED MISURER B: _ <br /> Drew&Hefner Water Well Drilling INSURERC___ <br /> 26452 Avenue 17 112 INSURER D: <br /> Madera,CA 93638 <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 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 /> INSR AODL SUS POLICY EFr POLICY� — LIMITS <br /> LTR TYPE OF INSURANCE JHsn WVD POLICY NUMBER ( M 1,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE <br /> AGE TO R000 <br /> CLAIMS-MADE FX]OCCUR � GIP384110 3/24!2019 3/2412020 DAMENTED 100,gEM�cES <br /> Wp EXP(A!Jf one p ) E__ 5,000 <br /> erson <br /> PERSONAL&ADV INJURY 3 1,000,000 <br /> G1EN'L AGGREGATE LIMR APPLIES PER: BENERAL AGGREGATE -__ S-- 000,000 <br /> POLICY X j LOC PRODUCTS-COMINOP AGG�S 2'00'00 <br /> OTHER E <br /> COMBINED SINGLE LIMIT <br /> AUTOMOBILE LIABILITY IaccJftr _ E__.._,_--- --- -_. <br /> ANY AUTO BODILY INJURY(Per person <br /> OWNS UTOSONLY I SCHEDULEDBODILYBODILY INJURY(Per acct len <br /> AUTOS DAMAGE <br /> AUTOSONLY AUTOST I erMdeM _ -_---- <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE E- <br /> EXCESS UAB CLAIMS-MADE AGGREGATE <br /> DED E E <br /> OTH- <br /> WORKERS COMPENSATION _--_ER <br /> AND EMPLOYERS'LIABILITY YIN _--�-� -- <br /> AN"PROPRIETOR/PARTNERIEXEcuTIVE F ] NIA F�L.EACHACC___ .. <br /> OFL7CER/MEMBEREXCLUDED? f EL.DISEASE-EAEMPLOYEE i _ - <br /> andatorym NH) <br /> If Y. describe under E.L.DIS -POLICY LIMIT s <br /> DESCRIPTION OF OPERATIONS below <br /> I <br /> DESCRIPTION OF OPERATIONS I LOCATIONS 1 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 /> AUTHORIZED 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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