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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
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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( NT <br /> CERTHOLDER COPY. <br /> STATE P.O. BOX 420807, SAN FRANCISCO;CA`94142-0807 <br /> COMPENSATION <br /> INSURANCE <br /> FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE: 11-01-2005 GROUP: 060044 <br /> POLICY NUMBER: 0020238-2005 <br /> CERTIFICATE ID:': 171 .. <br /> CERTIFICATE EXPIRES: 10-01-2006 <br /> 16-01-2005/10-01-2006 <br /> GEOLOGICAL TECHNICS, INC. NT <br /> 1101 7TH ST <br /> MODESTO CA 95354 <br /> This is to certify that we have issued::a valid Workers' Compensation insurance policy in a form approved by.the <br /> California Insurance Commissioner to the employer named below for the .policy period indicated. <br /> This policy is not subject to cancellation'by the Fund,except upon 30 .days advance written notice to the employer. . <br /> We will also give you 30:days advance notice should this policy be cancelled prior to its .normal expiration. <br /> This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage.afforded <br /> by the policy listed herein. Notwithstanding any requirement, term or condition of any contract.or other document <br /> with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br /> afforded by the policy described herein is subject to all the terms,-exclusions, and conditions, of such policy. <br /> AUTHORIZED REPRESENTATIVE PRESIDENT <br /> EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: - $1,000,000 PER OCCURRENCE. <br /> ENDORSEMENT #1600 - WAYNE WOODWARD SEC,TRES EXCLUDED. <br /> ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2001 I5 <br /> ATTACHED TO AND FORMS A PART.OF THIS POLICY: <br /> EMPLOYER <br /> WOODWARD DRILLING COMPANY, INC. (A CORP) ' NT <br /> PO BOX 336 <br /> RIO VISTA CA.94571 <br /> s <br /> [B10,NE] <br /> laEv.2-051 PRINTED 11-01-2005 . <br />
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