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COMPLIANCE INFO_2003-2009
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PR0231442
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COMPLIANCE INFO_2003-2009
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Last modified
8/10/2022 10:22:04 AM
Creation date
6/3/2020 9:49:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2003-2009
RECORD_ID
PR0231442
PE
2361
FACILITY_ID
FA0006441
FACILITY_NAME
QUIK STOP MARKET #5124*
STREET_NUMBER
505
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
217-260-21
CURRENT_STATUS
01
SITE_LOCATION
505 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231442_505 N MAIN_2003-2009.tif
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EHD - Public
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AC0 1?_ <br />CERTIFICATIMbF <br />DATEYY <br />LIABILITY I U W09126/07 <br />PRODUCER <br />TLB Insurance <br />3000 Oak Rd . , <br />Services <br />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 />Walnut Creek CA 94597 <br />Phone: 925-395-2600 Pax:925-287-0710 <br />INSURERS AFFORDING COVERAGE NAIL <br />INSURED <br />INSURER A. state Compensation Insurance <br />INSURER B: <br />MED EXP (Any one person) $ <br />INSURER C: <br />Walton Engineering, Inc. <br />West Sacramento CA 95691 <br />CLAIMS MADE [__� OCCUR <br />INSURER D: <br />INSURER E: <br />COV EKAUtb <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 OF INSURANCE <br />GENERAL LIABILITY <br />POLICY NUMBER <br />DATE MMIDDlYY) <br />EXPIRATION <br />DFFECTW ATE MMIDDM' <br />LIMITS <br />EACH OCCURRENCE $ <br />DAMAGE IV REN I <br />PREMISES (Ee occurence)$ <br />COMMERCIAL GENERAL LIABILITY <br />MED EXP (Any one person) $ <br />CLAIMS MADE [__� OCCUR <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMPlOP AGG $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY SEC LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ <br />(Ea accident) <br />ANY AUTO <br />ALL OWNED AUTOS <br />BODILY INJURY $ <br />(Per person) <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />BODILY INJURY $ <br />(Per accident) <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />AUTO ONLY: AGG $ <br />ANY AUTO <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />OCCUR CLAIMS MADE <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />A <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABIL.ITY <br />ANY PROPRIETOR/PARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />7130004927-07 <br />10/01/07 <br />10/01/08 <br />X ICER <br />E.L. EACH ACCIDENT $1000000 <br />E.L. DISEASE - EA EMPLOYE $1000000 <br />E.L. DISEASE - POLICY LIMIT $1000000 <br />It yes, describe under <br />SPECIAL PROVISIONS below <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES 1 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 />CERTIFICATE HOLDER <br />TOWHOKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI <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 IMPOSE NO OBLtGATK3N OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. _ <br />MCORD CORPORATION <br />ACORD 25 (2001108) © <br />
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