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COMPLIANCE INFO_2009-2018
EnvironmentalHealth
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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
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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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ACORD CE TIFIC T F LIABILITY I SU NC 0 S <br />WALTO-2. <br />DATE (MM/DDIYYY`() <br />09/25/08 <br />PRODUCER <br />TLB insurance Services <br />3000 Oak Rd., Suite 210 <br />Walnut Creek CA 94597 <br />Phone: 925-395-2600 Pax:925-287-0710 <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 />INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />Walton Engineering, Inc. <br />P.O. Box 1025 <br />West Sacramento CA 95691 <br />INSURER A: State compensation Insurance <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />rr�e,.cc. <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 />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICYELTR <br />DATE MMIFECDD <br />DATE MMIDD TI <br />LIMITS <br />REPRESENTATIVES. <br />GENERAL LIABILITY <br />Dennis Cote'�2& <br />EACH OCCURRENCE $ <br />PREMISES (Ea occurence) $ <br />COMMERCIAL GENERAL LIABILITY <br />MED EXP (Any one person) $ <br />CLAIMS MADE [_—] OCCUR <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ <br />_. <br />POLICY JECT LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED .SINGLE LIMIT <br />(Ea accident) $ <br />BODILY INJURY $ <br />(Per Peron) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY $ <br />(Per accident) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT. $ <br />THAN EA ACC , : $ <br />ANY AUTOOTHER <br />AUTO ONLY: AGG $ <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE $ - <br />AGGREGATE $ <br />OCCUR F1 CLAIMS MADE <br />$ <br />DEDUCTIBLE <br />_ ... .. $.. . <br />_ <br />.RETENTION $ . <br />- ... .. _.. ..... <br />. _ _ ,....._ _ ...... <br />_. .. <br />WORKERS COMPENSATION AND <br />Al <br />X TORY LIMITS ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />A <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTNE <br />OFFICERIMEMBER EXCLUDED? <br />000713-4927-2008 <br />10/01/08 <br />10/01/09 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />E.L. DISEASE -POLICY LIMIT $ 1,060,000 <br />If es. describe under <br />SPECIAL PROVISIONS below <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. Evidence of <br />insurance only. <br />cccT=rrnTG unl nFR GANGELLAI IUN <br />TOWHOMI <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/ -),n <br />/ <br />Dennis Cote'�2& <br />ACORD 25 (2001108) W A%.UKU GvrcrVMA r 1UN rpoo <br />
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