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COMPLIANCE INFO_2017 - 2018
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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LATHROP
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2300 - Underground Storage Tank Program
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PR0530093
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COMPLIANCE INFO_2017 - 2018
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Entry Properties
Last modified
11/20/2019 2:36:09 PM
Creation date
11/19/2019 2:48:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2017 - 2018
RECORD_ID
PR0530093
PE
2351
FACILITY_ID
FA0019793
FACILITY_NAME
CRUISERS MANTECA #29
STREET_NUMBER
1137
Direction
W
STREET_NAME
LATHROP
STREET_TYPE
RD
City
MANTECA
Zip
95336
APN
19724002
CURRENT_STATUS
01
SITE_LOCATION
1137 W LATHROP RD
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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---aaN ABLEMAI-CL DWATTS <br /> CERTIFICATE 4F LIABILITY INSURANCE DATE(MMIDD/YYYY) <br /> 10/12/2017 <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 CO TACT <br /> PONE George Petersen Insurance Agency,Inc. AHC,No,Ext):(707)525-4150 FAA/C,No:(707)525-4175 <br /> P.O.Box 3539 E-MAI <br /> Santa Rosa,CA 95402 .lnfo@gpins.com <br /> INSURERS AFFORDING COVERAGE NAIC A' <br /> INSURER A:Homeland Insurance Company of New York 34452 <br /> INSURED INSURER B:National Surety Corporation 21881 <br /> Able Maintenance Inc. INSURER C:State Compensation Insurance Fund 35076 <br /> 3224 Regional Parkway INSURER D: <br /> Santa Rosa,CA 95403 <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 /> LTR <br /> INSR TYPE OF INSURANCE ADDL SUER WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 10'000'000 <br /> CLAIMS•MADE ❑X OCCUR 793-00-26-72-0003 10/11/2017 10/11/2018 DPR <br /> AMAGE TSESO RfE,ENTED 50,000 <br /> X Pollution 8 Profess MED EXP(Any one rson 5'000 <br /> PERSONAL E ADV INJURY 10'000'000 <br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 10'000'000 <br /> POLICY T%8T 7 LOC PRODUCTS-COMP/OP AGG 10,000,000 <br /> OTHER: MOLD $ 1,000,000 <br /> B AUTOMOBILE LIABILITY (Ea accident) <br /> COMBINED SINGLE LIMIT $ 1,000,000 <br /> X ANY AUTO MZA80324816 04/01/2017 04/01/2016 BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> AREQ ON pyy��Ep pPe�acEclRdent IMAGE $ <br /> TOS ONLY AUTOS ONLY <br /> $ <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ <br /> C WORKERS COMPENSATION X <br /> PER UTE I OTH- <br /> AND EMPLOYERS'LIABILITY 9073219-17 10/01/2017 10/01/2018 1,000,000 <br /> ONFICER/MEIMBER EXCLUDED?ECUTIVE Y❑ N/A E.L.EACH ACCIDENT <br /> ( andatory In NF1) E.L.DISEASE-EA EMPLOYE 1'000'000 <br /> IFyyes,describe under 1,000,000 <br /> DESCRIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> B Auto Excess Only XAESS096639 04/01/2017 04/01/2018 4,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) <br /> RE: Proof of Coverage <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 /> Able Maintenance,Inc, ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 3224 Regional Parkway <br /> Santa Rosa,CA 95403 <br /> AUTHORIZED REPRESENTATIVE <br /> 1 VX, <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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