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COMPLIANCE INFO_2009-2015
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231320
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COMPLIANCE INFO_2009-2015
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Last modified
11/8/2022 2:49:25 PM
Creation date
6/23/2020 6:46:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2009-2015
RECORD_ID
PR0231320
PE
2361
FACILITY_ID
FA0003602
FACILITY_NAME
TESORO (SPEEDWAY) 68151
STREET_NUMBER
35
Direction
N
STREET_NAME
CHEROKEE
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04318003
CURRENT_STATUS
01
SITE_LOCATION
35 N CHEROKEE LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231320_35 N CHEROKEE_2009-2015.tif
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EHD - Public
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a- r <br />Y I r..1111'i I M <br />CERTIFICATE OF LIABILITY} �I <br />+» <br />milt 4311914FIA..:» , ► .-Mi 01IR <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 />-___--- <br />LTR <br />TYPE OF INSURANCE <br />ADOLINS <br />PROMCER 916-960-057.51 <br />:Dick.s Insurance Agency <br />'License #06T9244 .i 6 <br />P.O. 13ox 6 1 9D57 <br />POLICY NLWA�R <br />I a 916-960-0565 <br />^, <br />91"60-0581 <br />1 „ _ 0 <br />_dhfins.com <br />Roseville, CA 95661 <br />,. , Y,..: w.. <br />INSSha. • -:.r.COVERAGE <br />_RINSURER <br />A: Westchester Surplus L71nes <br />INSURED wi_lii�s onstruction, Inc. <br />URER a: The Travelers <br />» .. <br />i -hurst, CA .: .» s <br />:.:. . R C: State '. Fund <br />REN I ED <br />PREMISESyEa of a ancej_ <br />A <br />X COMMERCIAL GENERAL LIABIU!' f <br />X <br />INSURER . <br />624080134003 <br />06/30/11 <br />06130/12 <br />� <br />CLAWS,-MADE �]OCCl1R <br />� INSURER F, <br />!THIS IS TOCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE 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 />-___--- <br />LTR <br />TYPE OF INSURANCE <br />ADOLINS <br />POLICY NLWA�R <br />EFF <br />MMIDDMPVY <br />MPOLICY <br />MKtDNYICY YY <br />LIMITS <br />GENERAL LIABILITY <br />EACH GCCURRENCE S 1,000,00 <br />REN I ED <br />PREMISESyEa of a ancej_ <br />A <br />X COMMERCIAL GENERAL LIABIU!' f <br />X <br />624080134003 <br />06/30/11 <br />06130/12 <br />� <br />CLAWS,-MADE �]OCCl1R <br />MED EKP(Myoneper—) $ 5e00 <br />PERSONAL &ADV NJJRY $ _ 11DOOY 00( <br />X <br />Pplu11on <br />GENERA(,. AGGREGATE $ 2,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />I <br />PRODUCTS-COMPtOP PGG $ 2,000,00 <br />_ <br />POLICY PRO -LOC <br />Z�l <br />AUTOMOBILE LIABILITY <br />1ED COMBINEDSINGLE LIMIT ` 1.000.000 <br />BODILY INJURY (Perperson) $ <br />B <br />X ANY ALT o <br />501d911SEL <br />06130/11 <br />06130112 <br />BODILY INJURY (Per accident) $ <br />ALL OWNED SCHEDULED <br />AUTOS_ AUTOS <br />NON-0LN�ED <br />—--------------- <br />PROPERTY i��;F�--- $ <br />X HIRED ALITOS X AUTOSPer <br />accidenlZ,__ - <br />$ <br />UMBRELLA LIAR <br />EACH OCCURRENCE S 5+000.00 <br />AGGREGATE $ 5,0()0,000 <br />A <br />X <br />EXCESS LIAR <br />HOCO-IR <br />CLANS -MADE <br />G24080146003 <br />06/30/11 <br />W30112 <br />DED X RETENi ION .1 10,000 <br />S <br />WORKERS CONPENSAT70N! <br />X I VvC STATU- 01H - <br />I _CRY_...ER _.--- __._._—_____ <br />C <br />AN D EMPLOYERS' LIABILITI' <br />ANI PROPRIETORIPARTNERI0ECUPVE Y f N <br />7-1+ <br />71325653 <br />08/01111 <br />09/01112 <br />FL EACH ACCIDENT $ 1,000,00 <br />EL. DISEASE - EA EMPLOYEE $ 1Y ,00 <br />OFF,CER3NEMSER EXCLUDED -,I <br />{Mandatory In NH) <br />N f A <br />-- — —~ 1,000,00 <br />EL DISEASE -POLICY LIMIT $ <br />It yds, descrioe under <br />DESCRIPTION OF OPERATIGNS oeico <br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If mora space lsrequimd) <br />i,t a ♦ s rw or e" a e m +�^ ,: <br />THE EXPIRATION DATE ♦F, NOIICE WILL FIE DELIVEREO IN <br />ACCORDANCE WITH 7HE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORI <br />
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