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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HOWLAND
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16777
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2900 - Site Mitigation Program
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PR0543548
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Entry Properties
Last modified
6/3/2020 11:15:53 AM
Creation date
6/3/2020 10:30:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0543548
PE
2960
FACILITY_ID
FA0024728
FACILITY_NAME
SUPER STORE INDUSTRIES LATHROP DISTRIBUTION CENTER
STREET_NUMBER
16777
STREET_NAME
HOWLAND
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19816026
CURRENT_STATUS
01
SITE_LOCATION
16777 HOWLAND RD
P_LOCATION
07
QC Status
Approved
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TSok
Tags
EHD - Public
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YELLO-2 OP ID: DS <br /> ACORN CERTIFICATE OF LIABILITY INSURANCE DATE MM/ <br /> 03//30/22018018 ) <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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> Hill&Usher LLC NAME: Commercial Service Team <br /> Insurance. Bonds.Benefits. acCC N •602-956-4220INE AIc No: 602-956-4418 <br /> 3033 North 44th Street,#300E-MAIL <br /> Phoenix,AZ 85018 gg;doccontrol@hillusher.com <br /> Steve R.Shields INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Travelers Property Casuaky Co 25674 <br /> INSURED Yellow Jacket Drilling INSURER 13:Travelers Property Casualty Co 25674 <br /> Services LLC <br /> Richard LeBlanc dba INSURER C:Travelers Indemnity Co 25658 <br /> Yellow Jacket Drilling INSURER D:Homeland Insurance Co of NY 34452 <br /> PO Box 801 <br /> Gilbert,AZ 85299-0801 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 UB POLICY NUMBER POLICY EFF <br /> MMIDD/YY Y LIMITS <br /> LTR <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 <br /> CLAIMS-MADE -)C OCCUR X X DT-CO-2J407688-PHX-18 04/01/2018 04/01/2019 PREMISES Ea occurrence $ 300,00 <br /> MED EXP(Any one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 1,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,00 <br /> POLICY[X]J REC7 F—]LOC PRODUCTS-COMP/OP AGG $ 2,000,00 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000,00 <br /> Ea accident <br /> B X ANY AUTO X X DT-810-2J354550-TIL-18 04/01/2018 04/01/2019 BODILY INJURY(Per person) $ <br /> ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X NON-OWNED PROPERTY DAMAGE $ <br /> X <br /> HIRED AUTOS AUTOS Per accident <br /> X UMBRELLA LIAB Xd OCCUR EACH OCCURRENCE $ 10,000,00 <br /> B EXCESS LIAB CLAIMS-MADE CUP-2J444660-17-26 04/01/2018 04/01/2019 AGGREGATE $ 10,000,00 <br /> DED I X I RETENTION$ 10000 $ <br /> WORKERS COMPENSATION XPEROTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> YIN <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE X UB-2J440716-17-26 04/01/2018 04/01/2019 E.L.EACH ACCIDENT $ 1,000,00 <br /> OFFICERIMEMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 <br /> If yyes,describe under <br /> DESCRIPTIONOFOPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> B Equipment Floater 6601367M582 04/01/2018 04/01/2019 Insd equi as SChe <br /> D POLL/PROF HA00003302018 04/01/2018104/01/2019 Occ/Agg 10,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> RE: DRILLING SERVICES <br /> ADDITIONAL INSURED FORMS CGD46, OBENVGE301 & CAT353 ATTACHED. WAIVER OF <br /> SUBROGATION FORMS CGD316, OBENVGE319, CAT353 & WC000313 ATTACHED. <br /> CERTIFICATE HOLDER CANCELLATION <br /> GEOSYNT <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> GEOSYNTEC CONSULTANTS INC ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 10220 OLD COLUMBIA RD STE A <br /> COLOMBIA, MD 20146 AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />
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