My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2007-2011
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
C
>
CHRISMAN
>
34243
>
2300 - Underground Storage Tank Program
>
PR0231801
>
COMPLIANCE INFO_2007-2011
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/9/2022 9:10:07 AM
Creation date
6/23/2020 6:52:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2007-2011
RECORD_ID
PR0231801
PE
2361
FACILITY_ID
FA0003290
FACILITY_NAME
COUNTRY MART GAS & FOOD
STREET_NUMBER
34243
Direction
S
STREET_NAME
CHRISMAN
STREET_TYPE
RD
City
TRACY
Zip
95304-9334
APN
25318004
CURRENT_STATUS
01
SITE_LOCATION
34243 S CHRISMAN RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231801_34243 S CHRISMAN_2007-2011.tif
Tags
EHD - Public
Jump to thumbnail
< previous set
next set >
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
525
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
AC-ORD. CERTIFICATE OF LIABILITY INSURANCE OF ID NRDATE(NlWDDNYYY) <br /> CGRS -1 T 02/29/08 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> LEIN Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 4848 Thompson Pkwy ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Johnstown CO 80534 <br /> Phone:970-635-9400 Fax:970-635-9401 INSURERS AFFORDING COVERAGE MAIC <br /> INSURED INSURER A: ACE Westchester <br /> INSURER B ——i—n : an <br /> ny <br /> C G R S Inc. INSURER C' Pinnacol Assurance <br /> PO BOX 1489 INSURER D: st. eaul xzavolozn 1nuuEa o® <br /> Ft. Collins CO 80522 --- <br /> INSURER Ar onaut Insurance <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED IJAMED 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 HERE114 IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> IN VE POLICY EFFECTIPOLICY EXPIRAT1-0 <br /> LTR IHSRE TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/Yl') DATE MM/DD/YY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE S1,D00,000 <br /> T. <br /> A COMMERD IAL GENERAL LIABILITY G22071798-003 03/01/08 03/01/09 PREMISES(Ea occurenc0l SSD,000 <br /> CLAIMS MADE F.]OCCUR MED EXP(Any one person) $5,000 <br /> X POLLUTION/PROF aLKT ADD'L INS-CNV3100 PERSONAL BADV INJURY $1,000,000 <br /> CLAIMS MADE NAZVER-ENv3101 (ao-onl GENERAL AGGREGATE s2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 52,000,000 <br /> F-1 <br /> X PoucvPRC)f _ Emp Ben. 1,000,000 <br /> ELOC <br /> AU POLICY <br /> LIASILI—, <br /> . c0 IBI I D INGL LIMIT I. l00000 <br /> E �, <br /> j <br /> �uio <br /> ER FY <br /> I <br /> X Blanket <br /> e <br /> i, <br /> ' GARAGE uA91LL 1 <br /> AJl C J LY I7.1 <br /> ANYAUTC ( G T <br /> OTHC 1.1-I <br /> AUTO UL;LY' r V <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S <br /> OCCUR El CLAIMS MADE AGGREGATE $ <br /> 5 <br /> DEDUCTIBLE S <br /> RETENTION S S <br /> TATOTH- <br /> WORKERS COMPENSATION AND X TORY LIMITS X ER <br /> C, EMPLOYERS* <br /> IETOR AR 4029480 CO 01/01/08 01/01/09 E.L.EACH ACCIDENT $1000000 <br /> ANY PROPRIETOR/BER PARTNER/EXECUTIVE <br /> E OFF es.describe <br /> und.rCLUDED1 WC47678823233- CA E.L.DISEASE-EA EMPLOYEE 51000000 <br /> I(yes,describe untler <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 51000000 <br /> OTHER <br /> D Equipment Floater EP02050277 03/16/08 03/16/09 Rented/ $200,000 <br /> Leased $500 Ded <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> Certificate holder is named as additional insured with respects to the <br /> general liability, auto liability and the contractors pollution per <br /> referenced forms. <br /> CERTIFICATE HOLDER CANCELLATION <br /> FORINFP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL <br /> For Information Purposes <br /> Only IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUT IT�J fjE�RESE fATIV <br /> ACORD 25(2001108) �J� ©ACORD CORPORATION 1988 <br />
The URL can be used to link to this page
Your browser does not support the video tag.