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COMPLIANCE INFO_2009-2011
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2300 - Underground Storage Tank Program
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PR0231923
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COMPLIANCE INFO_2009-2011
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Last modified
2/1/2024 2:05:50 PM
Creation date
6/23/2020 6:54:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2009-2011
RECORD_ID
PR0231923
PE
2361
FACILITY_ID
FA0003606
FACILITY_NAME
ARCO 05450
STREET_NUMBER
1617
Direction
W
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95203
APN
13511015
CURRENT_STATUS
01
SITE_LOCATION
1617 W FREMONT ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231923_1617 W FREMONT_2009-2011.tif
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EHD - Public
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VOIT ,. CERTIFICATE LIABILITY INSURANCE <br />D03/23/10 Y) <br />PRODUCER LIC $0829370 1-925-244-7700 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Edgewood Partners Insurance Centers (Epic) <br />(San Raton Branch] <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />P. O. Box 503 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIL # <br />San Ramon, CA 94583 <br />SPICcartsMedgewoodins . com <br />INSURED <br />INSURER A: WESTCHESTER SIMPLDS LINES INS CO 10172 <br />Gettler-Ryan, Inc. <br />INSURERS: PEERLESS INS CO 24198 <br />6747 Sierra Court, Suite J <br />IINSURER C:TRAVELERS PROPERTY CAS CO OF AVER X25674 <br />INSURER D: <br />Dublin, CA 94568 <br />` <br />INSURER E: <br />rnvGoer_s=c <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 />ADDV i <br />POLICY NUMBER <br />POLICY EFFECMISAWTIVE <br />POLICY EXPIRATION <br />LIMITS <br />A <br />GENERAL LIABILITY <br />624014484003 <br />04/01/10 <br />04/01/11 <br />EACHOCCURRENCE $1,00_0,000 <br />DAMAGE TO RENTED <br />$50,000 <br />% COMMERCIAL GENERAL LIABILITY <br />_PREMISES(Esoccurence) <br />MED EXP (Any one person) $5,000 <br />CLAIMSMADE % 1 OCCUR <br />- <br />IPERSONAL&ADV INJURY $1,000,000 <br />GENERALAGGREGATE $2,000,000 <br />PRODUCTS-COMP/OPAGG $2,000,000 <br />GENLAGGREGATELIMITAPPLIESPER: <br />'... POLICY FXI PRO- ;LOC <br />B <br />AUTOMOBILE <br />% <br />LIABILITY <br />ANY AUTO <br />BAS404396 <br />04/01/10 <br />04/01/11 <br />COMBINED SINGLE LIMIT $$,000,000 <br />(Ee accident) <br />X <br />% <br />ALL OWNED AUTOS <br />SCHEDULEDAUTOS <br />BODILYINJURY $ <br />(Perparsen) <br />% <br />% <br />HIRED AUTOS <br />NON-OWNEDAUTOS <br />BODH-Y INJURY $ <br />(Peraccidem) <br />PROPERTYDAMAGE $ <br />(Per atxident) <br />[GARAGE LIABILITY <br />AUTO ONLY -EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />ANYAUTO <br />AUTO ONLY: AGG $ <br />A <br />EXCESSANMBRELLALIABIITY <br />624014502003 04/01/10 <br />04/01/11 <br />EACH OCCURRENCE $4,000,000 <br />AGGREGATE $4,000,000 <br />% OCCUR )' CLAIMS MADE <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />C <br />WORKERS COMPENSATION AND <br />DTJDB7827P41510 04/01/10 <br />04/01/11 <br />% WCSTAMTT O R <br />EL. EACH ACCIDENT $1,000,000 <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBEREXCLUDED? <br />E.L. DISEASE -EA EMPLOYEE $1,000,000 <br />Iyes describe under <br />SPECIALPROVISIONS tt®loe <br />E.L. DISEASE -POLICY LIMIT $1,000,000 <br />A <br />OTHER <br />Pollution <br />624014484003 04/01/10 <br />04/01/11 IPer Occurrence 11000,000 <br />A <br />B <br />Professional Liability <br />Rented/Leased Equipment <br />624014484003 04/01/10 <br />CBP0404796 04/01/10 <br />04/01/11 IPer Claim 11000,000 <br />04/01/11 Per Item 100,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES i EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Ut:KIIFIL:AICrVULUtK t+AN %'CL1-MInillLOU mayn..x,u" LUr avn-rayau u Ut --a <br />r" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />*EVIDENCE OF COVERAGE DATE THEREOF, THE ISSUING 04SURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />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 />REPRESENTATIVES. <br />Aurwamo REPRESENTATIVE /7 <br />ACORD 28 (2001108) ztalabsadeh CACORD CORPORATION 1988 <br />Ivo I*LAU <br />
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