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COMPLIANCE INFO_2013-2017
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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1403
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2300 - Underground Storage Tank Program
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PR0231995
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COMPLIANCE INFO_2013-2017
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Last modified
1/18/2023 1:49:12 PM
Creation date
6/3/2020 9:56:29 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2013-2017
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
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231995_1403 W COUNTRY CLUB_2013-2017.tif
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EHD - Public
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a <br />a WALTO.2 OP ID: SH <br />^" ® CERTIFICATE OF LIABILITY INSURANCE <br />DATE�Mro°""' <br />03M 1/2013 <br />PRODUCER Phone: 925-395-2600 <br />TLB Insurance Services <br />3000 Oak Rd., Suite 210 <br />Walnut Creek, CA 84697 <br />Dennis Cote' <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 />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Walton Engineering, Inc. <br />P.O. Box 1025 <br />West Sacramento, CA 95691 <br />INSURER A. Admiral Insurance Company <br />jNSURER 8: We8co Insurance Company <br />INSURER C: QBE Insurance Corp <br />INSURER D: HarfOrd Casualty Insurance CO <br />INSURER E: <br />COVERAGES <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 />INSR <br />ADM <br />OF INSURANCH <br />POLICY NUMBEROY <br />EFFECTNB <br />DATE IMMIDDrfYYY) <br />POLICY EXPIRATION <br />DATE fMM1DQ1YYYY1 <br />LIMITS <br />OENERAL LIABILITY <br />EACH OCCURRENCE S 1,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE 7 OCCUR <br />FEI-ECC-13587-00 <br />03/0612013 <br />03/06/2014 <br />s 60,00 <br />MED EXP one = 6,00 <br />PERSONAL & ADV INJURY S 1,000,00 <br />GENERAL AGGREGATE 3 2,000,00 <br />GERL AGGREGATE LIMIT APPLIES PER: <br />PRODUCT$ - COMP/OP AGG $ 2,000,00 <br />POLICYX PRO' LOC <br />Emp Ben. 1,000,00 <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANYAUTO <br />WPAI030224 02 <br />03106/2013 <br />03/0612014 <br />COMBINED SINGLE LIMIT i 1,000,00 <br />(Ea aoddeno <br />BODILY INJURY <br />(PER PERSON) s <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(PER ACCIDENT) s <br />HIRED AUTOS <br />NON-OWNEDAUTOS <br />PROPERTYDAMAGE $ <br />(PER ACCIDENT) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT i <br />OTHER THAN EA ACC 8 <br />AUTO ONLY: AGG $ <br />ANYAUTO <br />EXCIS81 UMBRELLA LIABILITY <br />EACH OCCURRENCE $ 10,000,00 <br />AGGREGATE s 10,000,00 <br />A <br />X OCCUR ❑ ctAIMs MADE <br />FEI-EXS-13588-00 <br />0310612013 <br />03/0612014 <br />s <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION S <br />WOR XER I COMPENSATION <br />X I WC STTIRYLIATLI- OTH- <br />MR <br />C <br />ANY RROP�RIHTOIUPARTNERIEXECUTIVE ITY YIN <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />QWC4000674 <br />10101/2012 <br />10/0112013 <br />E.L. EACH ACCIDENT $ 1,000,00 <br />E.L. DISEASE - EA EMPLOYEE $ 11000,00 <br />EL DISEASE - POLICY LIMIT S 1,000,00 <br />It saaie' <br />R N below <br />VWAR' <br />OTHER <br />A <br />Pollution/E80 <br />FEI-ECC43587-00 <br />03/06/2013 <br />03/0612014 <br />POII/E80 1,000,00 <br />D <br />Installation Fltr <br />57MSIZ6050 <br />03/06/2013 <br />1 03/1612014 <br />linst Fitr 2,000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />*10 days notice applies If cancelled for non-payment of premium. <br />TOWHOMI I SHOULDANYOFTHEABOVEDESCPJBEDPOLICIESSECANCELLEDBEFORETHEEXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br />To Whom It May Concern NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />AUTHOMMI)REPRESENTATVEDennis Cote' <br />ACORD 26 (2009/01) ®1988.2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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