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WP0040196
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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WP0040196
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Entry Properties
Last modified
1/23/2020 9:07:34 AM
Creation date
1/23/2020 8:55:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0040196
PE
4372
STREET_NUMBER
1679
STREET_NAME
LOWER SACRAMENTO
STREET_TYPE
RD
City
LODI
Zip
95242-
APN
05803029
ENTERED_DATE
10/22/2019 12:00:00 AM
SITE_LOCATION
1679 LOWER SACRAMENTO RD
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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SALEENG-01 MMAZZA <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) <br /> 11/29/2018 <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#OE02096 CRJ1 CT <br /> DiBuduo&DeFendis Insurance Brokers,LLC PHONE FAX <br /> Ext): FAX <br /> P.O.Box 5479 ( / N (559)432-0222- - (AIC,No):(559)431-7941 <br /> Fresno,CA 93755-5479 EMAIL <br /> ADDRESS: <br /> _I - <br /> _ INSURER(S)AFFORDING COVERAGE __ , NAIC# <br /> ENSURER A NalleyForge Insurance Co— - 20508 <br /> INSURED .INSURER B:Conti nenta_I-Casualty-Company- __ _ _ _ 20443 <br /> Salem Engineering Group,Inc. INSURER C:Continental Insurance Company .35289 <br /> 4729 W.Jacquelyn Ave. INSURER D:American Casualty_Company of Reading PA 20427 <br /> Fresno,CA 93722 <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 /> (NSR TYPE OF INSURANCE N DL SUER POLICY NUMBER PM/ICY EFF POLICY EXP) LIMITS <br /> LTR <br /> A X 1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 <br /> I CLAIMS-MADE I X I OCCUR X 6015893246 12/01/2018 12/01/2019 DAMAGETORENTED 300'000 <br /> _MED EXP_(Any one person $ _ <br /> 15,000 <br /> PERSONAL&ADV INJURY $ 2'000'000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4'000'000 <br /> POLICY X 1 PEST LOC PRODUCTS-COMP/OP AG_G $ 4'000'000 <br /> OTHER <br /> $ <br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> $ <br /> 1,000,000 <br /> (Per person)�(€a accident) p - - <br /> X ANY AUTO 6045473729 12/01/2018 12/01/2019 BODILY INJURY $ <br /> OWNED SCHEDULED — - -- '- <br /> AUTOS ONLY AUTOS <br /> pp BODILY INJURY(Per accident) $ <br /> . WN <br /> AUTOS ONLY IRE AUOTOS ONEDY PPe�aceRdentpAMAGE i$ <br /> - <br /> C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5'000'000 <br /> -'I-- <br /> Excess uAe CLAIMS-MADE' 6015893232 12/01/2018 12/01/2019 AGGREGATE $ 5'000'000 <br /> DED X RETENTION$ 10,000' r <br /> 1$ <br /> D WORKERS AND EMPLO ERS'LIABIILIITY YIN 1 X STAT EERH <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE '6020581635 12/01/2018( 12/01/2019 1,000,000 <br /> E.L.EACH ACCIDENT <br /> FFICER/MEMBER EXCLUDED9 NIA 1,000,000 <br /> If yes.story In and - E.L.DISEASE-EA EMPLOYEE $ _ <br /> If yes,describe under 1 � - -- <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1'000'000 <br /> B Prof./Pollution Liab AEH591895527 12/01/2018 12/01/2019 !Each Claim 2,000,000 <br /> B Prof./Pollution Liab AEH591895527 12/01/2018 12/01/2019 (Aggregate 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 /> *'Actual Certificate to be issued upon request** <br /> Certificate Holder is named Additional Insured(including Completed Operations and Primary Non-Contributory Wording)as respects General Liability per <br /> attached blanket policy form CNA75079XX(10-16). <br /> **Professional/Pollution Liability deductible per claim-$25,000 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> SAMPLE CERTIFICATE"' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> A-415 <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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