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COMPLIANCE INFO_2003-2009
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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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_co 9D OF LIABILITY INSU WOP ID S <br />ALTO -2 <br />DATE(MMDIYYYY) <br />03/06/07 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />TLB Insurance Services <br />1000 Broadway Suite 289 <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Oakland CA 94607-4090 <br />Phone: 510-628-9100 Fax:510-628-9115 <br />INSURERS AFFORDING COVERAGE MAIC# <br />INSURED <br />INSURER A: Evanston Insurance Co. <br />INSURER B: Redland Insurance Company <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSURER C: state couvensation Ineur—ce <br />Walton Engineering, Inc. <br />P.O. BOX 1025 <br />West Sacramento CA 95691 <br />INSURER D: Hartford Insurance Co 34690 <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED <br />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 />DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IRW <br />NSRrGENERAL <br />NSURANCE <br />POLICY NUMBER <br />FOQULTR <br />DATEYMMIDD <br />DATE MANDD/YY <br />LIMITS <br />EACH OCCURRENCE $1,000,000 <br />A <br />GENERAL LIABILITY <br />07PKG01395 <br />03/06/07 <br />03/06/08 <br />PREMISES (Ea occurence) $50,000 <br />MED EXP (Any one person) $ 5,000 <br />ADE ] OCCUR <br />PERSONAL &ADV INJURY $1,000,000 <br />DDE <br />GENERAL AGGREGATE s2,000,000 <br />PRODUCTS - COMP/OP AGG s2,000,000 <br />GENT AGGREGATE LIMB APPLIES PER: <br />SILL Ben. 1,000,000 <br />POLICY jE7 LOC <br />AUTOM0131LE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ 1,000,000 <br />(Ea accident) <br />B <br />X <br />ANY AUTO <br />8001121446 <br />03/06/07 <br />03/06/08 <br />ALL OWNED AUTOS <br />BODILY INJURY $ <br />(Per person) <br />SCHEDULED AUTOS <br />X <br />HIRED AUTOS <br />BODILY INJURY $ <br />(Per accident) <br />X <br />NON -OWNED AUTOS <br />I <br />PROPERTY DAMAGE $ <br />(Per accident) <br />AUTO ONLY - EA ACCIDENT $ <br />EA ACC $ <br />GARAGE LIABILITY <br />ANY AUTO <br />OTHER THAN <br />AUTO ONLY: AGG $ <br />EACH OCCURRENCE s4,000,000 <br />AGGREGATE s4,000,000 <br />EXCESSIUMBRELLA LIABILITY <br />El <br />07EFX00007 <br />03/06/07E03/06/08 <br />A <br />OCCUR CLAIMSMADE <br />is <br />DEDUCTIBLE <br />is <br />RETENTION $ <br />X TORY LIMITS ER <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY 713000492706 <br />10/01/06 10/01/07 E.LEACH ACCIDENT $1,000,000 <br />C PROPRIETOR/PARTNER/EXECUTIVE <br />ANY <br />�EXC NER/E ECUT� <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />OFFICER/MEMBER <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />i SPECIAL PROVISIONS below <br />� OTHER <br />07pKG01395 <br />03/06/07 03/06/08 Poll/E&O $1,000,000 <br />A Pollution/E&O <br />Fltr 57MSIZ6050 <br />03/06/07 03/06/08 last Fltr $1,000,000 <br />D Installation <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY <br />ENDORSEMENT 1 SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for <br />I <br />! <br />I <br />non-payment of premium. <br />CANCELLATION <br />CERTIFICATE HOLDER <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI <br />TOWHOMI <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 />i <br />REPRESENTATIVES.. <br />[AUTHORIZED REPRESENTATIVE <br />Dennis Cote' <br />© ACORD CORPORATION 198! <br />ACORD 26 (2001/08) <br />
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