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2900 - Site Mitigation Program
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PR0507835
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Last modified
3/5/2020 12:26:04 PM
Creation date
3/5/2020 11:23:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0507835
PE
2950
FACILITY_ID
FA0007793
FACILITY_NAME
SUPER STOP MARKET
STREET_NUMBER
290
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
22309101
CURRENT_STATUS
02
SITE_LOCATION
290 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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Client#: 354711° WOODWDRI <br /> ACORD- CERTIFICANv.t OF LIABILITY INSUFwtNCE 1DATE <br /> 1/01/05D ) <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Driver Alliant Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 516 West Shaw Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> f "te 102 <br /> RECEIVED NOV 0 2 2005 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 1 ano, CA 93704-2515 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Star Insurance Company <br /> Woodward Drilling Company, Inc. <br /> INSURER B: <br /> P. O. Box 336 <br /> INSURER C: <br /> Rio Vista, CA 94571 <br /> INSURER D: <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR <br /> TYPE OF INSURANCE POLICY NUMBER DDN POLICY EFFECTIVE POLICY EXPIRATION LIMITS <br /> LTR NSR DATE MM/DD/YY DATE MM/DD/YY <br /> A GENERAL LIABILITY CP0108492 08/20/05 08/20/06 EACH OCCURRENCE $2,000,000 <br /> X COMMERCIAL GENERAL LIABILITY DAMAGE <br /> AMAG ETo RENTED <br /> NToccurrence) <br /> $100 000 <br /> CLAIMS MADE u OCCUR MED EXP(Any one person) $5,000 <br /> X PD Ded:2,500 PERSONAL&ADV INJURY s2,000,000 <br /> GENERAL AGGREGATE s4,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s4,000,000 <br /> POLICY PRO LOC <br /> JECT <br /> A AUTOMOBILE LIABILITY CA0165365 08/20/05 08/20/06 COMBINED SINGLE LIMIT <br /> ANY AUTO - (Ea accident) $1,000,000 <br /> X ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS BODILY INJURY <br /> X NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> A EXCESS/UMBRELLA LIABILITY UM0165523 08/20/05 08/20/06 EACH OCCURRENCE s4,000,000 <br /> OCCUR FICLAIMS MADE AGGREGATE s4,000,000 <br /> DEDUCTIBLE $ <br /> X RETENTION $10000 $ <br /> WORKERS COMPENSATION AND WC STA U- 0TH- <br /> EMPLOYERS'LIABILITY _ TORY�1MIT <br /> IR <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> E.L.DISEASE-EA EMPLOYE $ <br /> If yes,describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT I$ <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> Certificate holder is added as an additional insured per form 2195 GL <br /> 09/99. 10 day notice of cancellation for non-payment of the premium <br /> applies. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> Geological Technics, Inc. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'An DAYS WRITTEN <br /> 1101 7st NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> Modesto, CA 95354 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2001/08) 1 of 2 #S133330/M132954 5BK 0 ACORD CORPORATION 1988 <br />
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