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COMPLIANCE INFO_2009-2010
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2300 - Underground Storage Tank Program
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PR0231995
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COMPLIANCE INFO_2009-2010
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Last modified
1/18/2023 11:36:29 AM
Creation date
6/3/2020 9:56:17 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2009-2010
RECORD_ID
PR0231995
PE
2361
FACILITY_ID
FA0006438
FACILITY_NAME
United # 5446
STREET_NUMBER
1403
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12323246
CURRENT_STATUS
01
SITE_LOCATION
1403 W COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231995_1403 W COUNTRY CLUB_2009-2010.tif
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EHD - Public
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i ,O ® DATE (MM/DDNYYY) <br />A�CERTIFICATE_ ®_ F LIABILITY I SU _NCE 04/27/2_0_09 <br />PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION <br />Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />4400 Comerica Bank Tower HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />1717 Main St. I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Dallas, TX 75201-7357 <br />Attn: dallas.certs@marsh.com 212-9418-0519/866-966-4664 <br />044933—ALL-09-10 WAYN GAW <br />INSURED <br />Dresser, Inc. <br />15455 Dallas Parkway, Suite 1100 <br />Addison, TX 75001 <br />INSURERS AFFORDING COVERAGE <br />TYPE OF INSURANCE <br />NAIC # <br />INSURER A: Liberty Mutual Fire Ins Co <br />POLICY EXPIRATION <br />DATE (NIWDOIYYYY) <br />123035 <br />INSURER B: Liberty Insurance Corporation <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE a OCCUR <br />42404 <br />INSURER C. N/A <br />05/01/2010 <br />N/A <br />INSURER D: N/A <br />— <br />MED EXP (Any one person) $ 10,0001 <br />— <br />N/A <br />INSURER E: <br />_ <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />j MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br />IlA1C — CI ILLI — —1— -- 1 IAAITC CLIrNIA/AI AAAV UA\rC QCCA1 Dr-ni Ircr1 RV DAlrl rl AIhAC <br />INSR ADD' <br />LTR INSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE (MWDDNYYY) <br />POLICY EXPIRATION <br />DATE (NIWDOIYYYY) <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE a OCCUR <br />TB2-691-004177-179 <br />05/01/2009 <br />05/01/2010 <br />EACH OCCURRENCE2.000.0001 <br />DAMAGE TO RENTED $ 2,000,000; <br />PREMISES Ea occurrence <br />— <br />MED EXP (Any one person) $ 10,0001 <br />— <br />PERSONAL &ADV INJURY $ 2,000,0001 <br />_ <br />GENERAL AGGREGATE$ 5,000,0001 <br />GENERAL AGGREGATE LIMIT APPLIES PER <br />- POLICY PRO LOC <br />JECT <br />PRODUCTS - COMP/OP AGC5,000,00 0 <br />----- -- -- <br />i <br />A AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />AS2-691-004177-039 <br />05/01/2009 <br />05/01/2010 <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ 2,000,0001 <br />BODILY INJURY $ <br />ALL OWNED AUTOS <br />j <br />1 <br />SCHEDULED AUTOS <br />(Per person) <br />BODILY INJURY $ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE'. <br />(Per accident) $ <br />j <br />j <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />ANY AUTO <br />j <br />I <br />OTHER THAN EA ACC $ <br />AUTO ONLY: <br />AGG $ <br />! EXCESS / UMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />AGGREGATE $ I <br />I <br />�I OCCUR I CLAIMS MADE <br />$ <br />- <br />I <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />A <br />B <br />B <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N <br />OFFICER/MEMBEREXCLUDED? <br />N <br />(Mandatory in NH) K es, describe underE.L. <br />SPECIAL PROVISIONS below <br />WA7-69D-004177-119 (AOS) <br />WC7-691-004117-129(VVI) <br />WA7-69D-004177-199(WV) <br />05/01/2009 <br />05/01/2009 <br />05/01/2009 <br />05/01/2010 <br />05/01/2010 <br />05/01/2010 <br />X WC SORYTATU- 0TH- <br />EI IMITq ER <br />.L. EACH ACCIDENT $ 2,000,000 <br />.L.DISEASE- EAEMPLOYE $ _ 2,000,0001 <br />DISEASE - POLICY LIMIT $ 2,000,000 <br />i <br />OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />RE: DRESSER, INC., DRESSER WAYNE SERVICES GROUP <br />rCGTIcIr ATC Nni Ica uni I nna 4121)Qnn a4 CANCFI I.ATIAN <br />AGORD 25 (ZUUUIUT) V IVVt$-ZUUy AGUtCu UVKrUKAI IVIV. All K191FIc5 Me5erveU <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />DRESSER, INC., DRESSER WAYNE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />SERVICES GROUP <br />30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND <br />INSURER, ITS AGENTS OR REPRESENTATIVES. <br />{�U{POgNEp REpTJ�HE <br />AOf Ma. USA IIICSENTAtIYE ' I ,I"�" <br />K/ <br />William Hines ! <br />AGORD 25 (ZUUUIUT) V IVVt$-ZUUy AGUtCu UVKrUKAI IVIV. All K191FIc5 Me5erveU <br />The ACORD name and logo are registered marks of ACORD <br />
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