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COMPLIANCE INFO_2011-2012
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PR0231476
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COMPLIANCE INFO_2011-2012
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Last modified
2/9/2024 1:14:37 PM
Creation date
6/23/2020 6:49:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2011-2012
RECORD_ID
PR0231476
PE
2361
FACILITY_ID
FA0000684
FACILITY_NAME
QUIK STOP MARKET #3125
STREET_NUMBER
1580
Direction
W
STREET_NAME
MAIN
STREET_TYPE
ST
City
RIPON
Zip
95366
APN
259-090-21
CURRENT_STATUS
01
SITE_LOCATION
1580 W MAIN ST
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231476_1580 W MAIN_2011-2012.tif
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EHD - Public
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WALTO-2 OP ID: SH <br />`1111k, " CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) <br />'- <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS <br />10/07/11 <br />PRODUCER 925-395-2600 <br />3000 TLB Insurance Services <br />Oak Rd.,Suite 210 <br />Wal <br />Walnut Creek, CA 9459597 <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 />NSR1 <br />TYPE OF INSURANCE <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Walton Enggi�neering, Inc. <br />P.O. Box T025 <br />INSURER A: Praetorian Insurance <br />West Sacramento, CA 95691 <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />rnvco w n_o� <br />INSURER E: <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 <br />MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS <br />AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />NR DD' <br />ILTR <br />NSR1 <br />TYPE OF INSURANCE <br />POLICY NUMBERDATE <br />POLICY EFFECTIVE <br />POLICY EXPIRATION <br />fMM/DDNYYY) <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />COMMERCIAL GENERAL LIABILITY <br />DAMAGE TORERrEff_- <br />PREMISES Ea occurence $ <br />MED EXP (Any one person) $ <br />CLAIMS MADE OCCUR <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ <br />PRO LOC <br />POLICY ]JECT F-1 <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />$ <br />ANY AUTO <br />(Ea accident) <br />ALL OWNED AUTOS <br />BODILY INJURY $ <br />SCHEDULED AUTOS <br />(Per person) <br />HIRED AUTOS <br />BODILY INJURY $ <br />NON -OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />ANY AUTO <br />OTHER THAN EA ACC $ _ <br />AUTO ONLY: AGG $ <br />EXCESS / UMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />OCCUR EICLAIMS MADE <br />AGGREGATE $ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />$ <br />WORKERS COMPENSATIONWC <br />X STATU- OTH- <br />A <br />AND EMPLOYERS' LIABILITY <br />T RY LIMIT ER <br />E.L. 1,000,00 <br />ANY PROPRIETOR/PARTNER/EXECUTIVEYa <br />QWC4000674 <br />10/01/11 <br />10/01/12 <br />OFFICER/MEMBER EXCLUDED? <br />EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,00 <br />(Mandatory in NH) <br />If es, describe under <br />E.L. DISEASE -POLICY LIMIT $ 1,000,00 <br />SPECIAL PROVISIONS below <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. <br />EIDENCE OF INSURANCE ONLY <br />TOWHOMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <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 SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />AUTHORIZED REPRESENTATIVEDennis Cote' <br />^"�^w Awv�,v ► v 7958-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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