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2900 - Site Mitigation Program
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PR0543479
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SITE INFORMATION AND CORRESPONDENCE
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Entry Properties
Last modified
5/5/2020 9:58:34 AM
Creation date
5/5/2020 9:11:45 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0543479
PE
2960
FACILITY_ID
FA0024679
FACILITY_NAME
CANEPA'S CAR WASH
STREET_NUMBER
6230
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95204
APN
081360030
CURRENT_STATUS
01
SITE_LOCATION
6230 PACIFIC AVE
P_LOCATION
01
QC Status
Approved
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EHD - Public
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Feb 11 03 12 : 52p —.p OF Stoo' ktonPW - Permit [ 200-. 37 - 8901 p . l <br /> �r- E GATE (YINO@YY1 ¢j <br /> _ FAX THIS CERTIFICATE 7S ISSUED AS A MA7T�R OF IAQ <br /> mum <br /> NFORhiAT10N <br /> QNLY AND CONFERS NO RIGNTS UPON THE CERTIFICATE <br /> AHL°TER T+,EtAVE MFE AFFORpE�D ar TYSe Ll0fl1.OR <br /> c <br /> SAMPLE COiEPANiE3 AFFORDING <br /> we <br /> ACTUAL CCOVERAGEITY�EQUdP,EMENTS w��. ............ ........ .._............._ -........ ...... ....... <br /> { COMPLETE ) p NAME <br /> SAMPLE DaMBANY N. ..AM..E <br /> .. '4 . .. . . ...... .............. ..... <br /> ACTUAL MF EQUIREMENTS COMPANY NAME <br /> (COMPLETE ) .._°..... .... . ......... . .. _............... I . .... <br /> COMPANY <br /> D <br /> THIS IS TO CE9TIF1' THAT THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED THE INSURED NAMEO ABOVE FORTH POLICY PE91CD <br /> INDICATED, NONIRHSTANOINGANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIF=T& E MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE IS SUBJECTTO ALL THE TERMS, <br /> EXCLUSELWS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN RW UCEO BY PAID CLAWS. <br /> . .. ........... .. .................................. . .. ....-......,..I..I..I ......I.I...-.. ..I.. <br /> .. ...... ...... ...........;........ <br /> ............__......... ... ... ...._.. ... ......I.. ...... .. ,. , ,. . . . . .. . .. ..... <br /> TYPE OF INSURANCE Pouey Nu)AYERRa�IM D POL10YDOW ��N : ITS <br /> GENEMs L1ASUM <br /> GENERAL AGGREGATE s 1 , 000 , 000 <br /> X couuEReuLGEHErALLwtry PR0DUCis.ca�OPAGU 111 s 1000,Ob0 <br /> syt. ... _... ._....._-......._.__......_.._...... .. .L..... . . ..... <br /> CLAIMS MAD! X OccuR ' ( COMPLETE ) ( COMPLETE ) PER9oruLdALNINJURY s 1 , 000 , 000 <br /> aD 00 , 000 <br /> . •.... CYlN@R'S x CONTRACTORS PRDT : ....._E ORANGE (!!0' aYTnt ..._�....-.__ a ASO ., 000 <br /> - I.........._................ <br /> DEDUCTIBLE ) <br /> ' NEO E%P (PY+Yw Pnsml y' . Q , <br /> AU'TOMOEEJE WBILJTY ' <br /> ._.. . ( COMPLETE ) COMBINED SINGLE LIMB ' 00 <br /> ALL OYINEDAUTOS ( COMPLETE ) _. .. 1000 , 0 <br /> ANY ALmu � <br /> ..X.. SCHEDULEDAVRTS (PwOprwQRY <br /> $ <br /> X HIREOAUTOS .- .. , . .. . ... . . . I ... .... I.. <br /> X NOHJYWBODILY INJURY S <br /> NEO AUTOS w Pme.YE <br /> ( DEDUCTIBLE <br /> ........ .__..•,......._....:_..,.........__....._.... P1itlPERTT CAAVM'E S <br /> ^OMAGE LIABILITY zAUTO ONLY . EAACpOENT i <br /> ANY AUFO i «••r �r.nwM:�= <br /> -. OTHERTHAN AUTO ONLY: : «; -�:. X�IZ�:,c��..:� i <br /> ........ ....__................___...,......_..,_._ j + EACHACCIDENT i <br /> AGGREGATE S <br /> FSCE6$ LIABILITY <br /> I EACH OCCURRENCE S <br /> ...................... .. .__ I,I.I ......-. .. .._ <br /> .. . . . .._.. <br /> .. UMBRELLAELIA FORM .. ..... <br /> AGGREGATE <br /> OTHER TL{N UMBRELLA H91W i <br /> .._.... ........... •..... ......... . ... ..._.q. ..... .. ... . ... . <br /> -. ' TORY LHNITsi i .ER ,, _,.. ..,� .�... .: <br /> WORKERS COMPENSATION AND ..::: <br /> ERS' <br /> EMPLOYLNOiLJT'( dw;V. .%. :., <br /> TNEPROPRiETORJ : CDEDUCTPIBLEj ` ( COMPLETE ) E�'_ .. ._.. .._... . . . . ..__ .. ...... . .. .. 9.2 <br /> ..-- _ EACHACCIMW . .i. . .l s. �.s.Q.�.Q..... <br /> PARTNERSiIEXECUTNE EL O �,.EASE._..._..._......_T <br /> ...... ., ANCI <br /> ISEASE -POUCY iiNR i <br /> OFFiCERSARE: ETXCL <br /> O7NI EI OISFASE-EAEMPLOYEE s <br /> ✓ CITY O STOCKTON , ITERS OFFICCEERSS,, AGENTS & EMPLOYEES ARE NAMED AS ADDITIONAL INSUREDS PER THE <br /> TACHED ENDORSEMENT , <br /> ACELLATION : EXCEPT SO DAY NOTICE FOR NON PAYMENT OF PREMIUM <br /> . FCL:AE�"i� . ,,�..t, . K.-�.�RN��a....:'; ..�..�,vs.�.::'�s,'. <br /> SHOULD ANY OF THEABDVl DESCMSFD POGGEB EE ^""'� '^ EEFDRE THE <br /> E1GIRATN7N DI17ETfi7tE0i, THE ISSUING COYPANYYYS � MAA <br /> QTY OF STOCKTON , 30 DAYSINWiTEN 80=70 TME CER141FiTEHOLDOP NAM YO THE LEFT, <br /> CITY HALL ANNEX <br /> 6 EAST LINDSAY STREET <br /> STOC'KTON , CA 95202 Aumcna CRBPROBNTATNM <br /> CtEGD § 5 & � e � 3F �� �5k : � xid370tkt <br />
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