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2900 - Site Mitigation Program
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PR0540822
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Entry Properties
Last modified
5/28/2021 3:30:30 PM
Creation date
5/13/2020 3:05:22 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0540822
PE
2960
FACILITY_ID
FA0023389
FACILITY_NAME
FORMER HELENA CHEMICAL FACILITY
STREET_NUMBER
2245
Direction
W
STREET_NAME
CHARTER
STREET_TYPE
WAY
City
STOCKTON
Zip
95206
APN
16336017
CURRENT_STATUS
01
SITE_LOCATION
2245 W CHARTER WAY
P_LOCATION
01
QC Status
Approved
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EHD - Public
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DATE(MMIDDlYYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE <br /> 3/21/2019 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Crystal&Company PHONE FAX <br /> Crystal IBC LLC c o •800-221-5830 ac No):800-383 1852 <br /> 32 Old Slip A RI <br /> DESS: <br /> New York NY 10005 INSURE S AFFORDING COVERAGE NAIC# <br /> INSURER A:ACE American Insurance Co 22667 <br /> INSURED CASCDR INSURER B:ACE Fire Underwriters Insurance Company 20702 <br /> Cascade Drilling, LID <br /> SE, Suite 228 <br /> 22722 29th Drive SINSURER C:Allied World Assurance Company U.S. 1 19489 <br /> Bothell,WA 98021 INSURER D:Lloyd's of London <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:1594965738 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDLTYPE OF INSURANCE IVSD WVD SUER POLICY NUMBER POLICY <br /> MMIDD� LIMITS <br /> LTR <br /> D X COMMERCIALGENERALLIABILITY ENVP000015018 11/1/2018 11/1/2019 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO REN <br /> CLAIMS-MADE FR-1 OCCUR PREMISES Ea occurrence $300,000 <br /> MED EXP(Any oneperson) $25,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> X POLICY E PRO- ❑LOC <br /> JECT PRODUCTS•COMP/OP AGG $2,000,000 <br /> OTHERS Professional Liabili $1,000,000 <br /> A AUTOMOBILE LIABILITY ISAH25271956 11/1/2018 11/1/2019 COMBINED SINGLE LIMIT $5,000,000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> D UMBRELLALIAB X OCCUR ENVX000011718 11/1/2018 11/1/2019 EACH OCCURRENCE $5,000,000 <br /> X EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000,000 <br /> DED I I RETENTION$ $ <br /> A WORKERS COMPENSATION WLRC6543482911/1/2018 11/1/2019 X <br /> B AND EMPLOYERS'LIABILITY YIN SCFC65434866 11/1/2018 11/1/2019 STATUTE ERH <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 <br /> OFFICER/MEMBEREXCLUDED? FNJ NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> If yes,descr be under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 <br /> D Pollution Liability ENVP000015018 11/1/2018 11/1/2019 Each Poll Incident 1,000,000 <br /> C Excess Liability 03110034 11/1/2018 11/1/2019 Excess Occurrence <br /> $10,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) <br /> GENERAL LIABILITY: Additional Insured status when required by written contract(GAP1028 6/1/2016,GAP1004 6/1/2016);Additional Insured <br /> Primary/Non-Contributory Amendatory when required by written contract(GAP1005 6/1/2016);Waiver of Subrogation when required by written contract <br /> (GAP1030 6/1/2016). <br /> AUTOMOBILE: Additional Insured status when required by written contract(DA9U74c 0316);Primary/Non-Contributory when required by written contract <br /> (DA21886b 0614);Waiver of Subrogation when required by written contract(CA0444 1013) <br /> WORKERS'COMPENSATION: Waiver of Subrogation when required by written contract-Other States(WC000313 1105);Waiver of Subrogation when <br /> See Attached... <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Condor Earth <br /> 188 Frank West Circle Suite I AUTHORIZED REPRESENTATIVE <br /> Stockton, CA 95206 <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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