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COMPLIANCE INFO_2009-2018
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2300 - Underground Storage Tank Program
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PR0231130
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COMPLIANCE INFO_2009-2018
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Last modified
11/15/2023 10:37:32 AM
Creation date
4/27/2020 12:23:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2009-2018
RECORD_ID
PR0231130
PE
2361
FACILITY_ID
FA0002232
FACILITY_NAME
QUIK STOP MARKET #3132*
STREET_NUMBER
3555
Direction
W
STREET_NAME
HAMMER
STREET_TYPE
LN
City
STOCKTON
Zip
95209
APN
071-180-20
CURRENT_STATUS
01
SITE_LOCATION
3555 W HAMMER LN
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231130_3555 W HAMMER_2009-2018.tif
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EHD - Public
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MD CERTIFICAT F LIABILITY I SU NC OP ID s <br />A WALTO-2 <br />DATE(MMIDDlYY <br />.09/25/08 <br />PRODUCER <br />TLB Insurance Services <br />3000 Oak Rd., Suite 210 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />POLICY NUMBER <br />Walnut Creek CA 94597 <br />Phone: 925-395-2600 Fax:925-287-0710 <br />INSURERS AFFORDING COVERAGE MAIC# <br />INSURED <br />INSURERA: . Hudson Insurance Company <br />INSURER 8: Delos Insurance Co. <br />GENERAL LIABILITY <br />INSURER C: Hartford Insurance Co 34690 <br />Walton Engineering, Inc. <br />P.O. Box 1025 West Sacramento CA 95691 <br />INSURER D: state comensation insurance <br />INSURER E. <br />NV V GRMVGa <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 />LTR <br />NS <br />TYPE OP INSURANCE <br />POLICY NUMBER <br />170MVIFFECTIVE <br />DATE MM/DO <br />EX <br />DATE MMlDDIYY <br />LIMITS <br />REPRESENTATIVES. <br />GENERAL LIABILITY <br />Dennis Cote' <br />2 �Ae� LA nnA0AT1A\I A[f00 <br />EACH OCCURRENCE $ 1,000,000 <br />PREMISES Eaoccu're nce $ 50,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE ® OCCUR <br />FEC7001958 <br />03/06/08 <br />03/06/09 <br />MED EXP (Any one person) $ 5,000 <br />PERSONAL &ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE s2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG $ 2,000,000 <br />SIA Ben. 11000,000 <br />LO <br />POLICY X JEC C <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />DPA5501792 <br />03/06/08 <br />03/06/09 <br />COMBINED SINGLE LIMIT „$ 1,000,0.00. <br />(Ea accident) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY $ <br />(Per person) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />BODILY INJURY $ <br />Per accident) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ . . <br />EA ACC $ <br />OTHER.THAN <br />AUTO ONLY: AGG $ <br />ANY AUTO <br />EXCESSIUM13RELLALIABILITY <br />EACH OCCURRENCE $ 4, 000, 000 <br />AGGREGATE $4,000,000 <br />A <br />X OCCUR FICLAIMS MADE <br />FXS7001959 <br />03/0`6/08 <br />03/06/09 <br />$ <br />DEDUCTIBLE <br />$.... _. _ .. ..... <br />_ ... <br />�_'RETENTION.. -$ <br />_. _ .- ..._ .... ................. . . <br />.. _._ ...._ . - . - <br />. __ .. <br />WORKERS COMPENSATION AND <br />TUOTK- <br />X I TORY LIMITS I I ER <br />E.L. EACH ACCIDENT $ 1,.000,000 <br />D000713-4927-2008 <br />EMPLOYERS'. LIABILITY <br />ANY PROPRIETOR#ARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />10/01/08 <br />10/01/09 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />H yes, describevnder <br />SPECIAL PROVISIONS below <br />OTHER <br />A <br />C <br />Pollution/E&O <br />Installation Fltr <br />PEC7001958 <br />57MSIZ6050 <br />03/06/08 <br />03/06/08 <br />03/06/09 <br />03/06/09 <br />Poll/B&O 11000,000 <br />Inst Fltr 11000,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of. premium. <br />I.IAI ACD t."Mt.P_LI_N I IVIY <br />fl.Ot1SSO1lT <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />To Whom It May Concern <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />��, <br />Dennis Cote' <br />2 �Ae� LA nnA0AT1A\I A[f00 <br />ACORD 26 (2001/08) <br />
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