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COMPLIANCE INFO_2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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JACK TONE
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1501
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2300 - Underground Storage Tank Program
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PR0505264
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
3/4/2021 8:17:39 AM
Creation date
1/17/2020 11:56:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0505264
PE
2361
FACILITY_ID
FA0006672
FACILITY_NAME
FLYING J TRAVEL PLAZA #618*
STREET_NUMBER
1501
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
22811017
CURRENT_STATUS
01
SITE_LOCATION
1501 N JACK TONE RD
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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JONECOV-02 DADAGAYa <br /> ACORO' <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)7/1/2019 <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 pollcy(les)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 q OE67766 MIACT Almle Dadacay <br /> IDA Insurance Services ac°No Ern: 949 297-5530 52002 Fiu c No: 949 297-5960 <br /> 130 Vantla <br /> Suite 250 JAIIJ..almle.dadacay@loausa.com <br /> Allso Viejo,CA 92656 <br /> INSURERISI AFFORDING COVERAGE MAIC <br /> INSURER A:Colony Insurance Company 39993 <br /> INSURED INSURER s;Everest National Insurance Company 10120 <br /> Jones Covey Group,Inc. INSURE C:Travelers Property Casualty Company of America 25674 <br /> 9595 Lucas Ranch Road Ste 100 I u E D: <br /> Rancho Cucamonga,CA 91730 <br /> INSURERE: <br /> INSURER F: <br /> COVERAGE 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 TYPE OF INSURANCE ADDL SUER NM POLICY NUMBER LIMITS <br /> POUCYEXPITR LIMRa <br /> A X COMM ERCULL GENERAL LU1BILrY HOCC RRENCE 5'000,000 <br /> CLAIMS-MADE OCCUR PACE305425 7/1/2019 7/1/2020 DAMAGETORENTED 500,000 <br /> 0 ons 25,000 <br /> PERSONAL 6 ADV INJURY S 5,000'000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 5,000,000 <br /> POLICY OX jeer F]LOC PRODUCTS•COMP/OP AGO 5,000,0OO <br /> OTHER. PRODUCTS POLLUT Included <br /> COMBINED SINGLE LIMIT 1000,000 <br /> B AUTOMOBILE LIABILITY _ <br /> X ANY AUTO CFICA00102191 7/1/2079 7/1/2020 BODILY INJURY Par rson <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTTOOSyy O BODILY Par accident <br /> AUTOS ONLY AUTOS ONM FSee d nl AGE <br /> A UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 6.000.000 <br /> X EXCESS LIAR CLAIMS-MADE EXC305426 7/1/2019 7/1/2020 AGGREGATE 6,000.000 <br /> DEO X RETENTIONS 0 <br /> B WORKERS COMPENSATION X PERTUTr <br /> ON+ <br /> ANDEMPLOYERa�LIABILITY CA10002046191 6/112019 5/1/2020 1,000,000 <br /> ANY PROPRIETOR/PARTNERlEXECLITIVE Y/ E.L.EACHA C NT <br /> OFeF dE E.MA fj EXCLUDE09 Y NIA <br /> 1(�M t I .L. PLOYS 1'000'OOO <br /> M .describe under 11000,000 <br /> IPT'ONF P&RATIONS belowE.L.DISEASE-POLICY LIMIT $ <br /> C LeasedlRsnted Equip. 6602G408239 7/1/2019 71112020 bed:$1,000; 300,000 <br /> A Contractors Poll El I PACE305425 7/112019 71112020 5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addhlonal RemarNs Schedule,may be attached If mora space In required) <br /> Proof of Coverage <br /> CERTIFICATE HOLDS CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> lingtirad's Verification <br /> ertnwn gr roniAmm r n-foaaamis ernan rnuvnPATlnN All rlr h►.—o.. A <br />
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