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COMPLIANCE INFO_2008-2009
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0232257
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COMPLIANCE INFO_2008-2009
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Last modified
12/13/2023 1:52:27 PM
Creation date
6/23/2020 6:54:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2008-2009
RECORD_ID
PR0232257
PE
2361
FACILITY_ID
FA0000670
FACILITY_NAME
QUIK STOP MARKET #3148*
STREET_NUMBER
205
Direction
W
STREET_NAME
LOCKEFORD
STREET_TYPE
ST
City
LODI
Zip
95240
APN
04116115
CURRENT_STATUS
01
SITE_LOCATION
205 W LOCKEFORD ST
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0232257_205 W LOCKEFORD_2008-2009.tif
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EHD - Public
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C <br /> CERTIFICATE F LI [LIQ INS <br /> ES G OP ID s DATE(MM,DD,YYYY) <br /> WALTO-2 . 09/25Z08 <br /> PRODUCER THIS CERTIFICATE I$ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> TLB Insurance Services HOLDER.THIS CERTIFICATE DOES NOT AMEND,.EXTEND OR <br /> 3000 Oak Rd. , Suite 210 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Walnut Creek CA 94597 <br /> Phone: 925-395-2600 P'ax:925-287-071.0 INSURERS AFFORDING COVERAGE MAIC# <br /> INSURED INSURERA Hudson Insurance Company <br /> INSURER B: Delos Insurance Co. <br /> Walton Engineering, Inc. INSURER C: Hartford Insurance Co 34690 <br /> P.O. Box 1025 INSURER 0: state Compensation Znsnaanca <br /> West Sacramento CA 95691 INSURER E.' <br /> COVERAGES <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 CONTRACTOR 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 /> .POLICY <br /> MTION <br /> LTR NS TYPE OF INSURANCE <br /> POLICY NUMBER DATE MMIDD DATE MMtDD(YY LIMITS <br /> GENERAL LIABILITY II EACH OCCURRENCE $ :L,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY FEC7001958 1 03/06/08 03/06/09 PREMISES(Eaoccurance) $ 50,000 <br /> CLAIMS MADE a OCCUR ! MED EXP(Any one person) $ 5,000 <br /> PERSONAL S ADV INJURY S 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> PRODUCTS-COMPIOPAGG S 2,000,000 <br /> GEWL AGGREGATE LIMIT APPLIES PER: <br /> POLICY X JE7 LOC Sm BGA. 1,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,00 0,0.0 0. <br /> . . <br /> 03./06/08 (Eaaccident) <br /> B X <br /> ANY AUTO DPA5 5 017 9 2 03/06/09 <br /> ALL'OWNED AUTOS 90DILY INJURY $ <br /> (Per person) <br /> SCHEDULED AUTOS <br /> HIRED AUTOS t t BODILY INJURY $ <br /> (Per accident) <br /> NON-OWNED AUTOS <br /> PROPERTY DAMAGE S <br /> (Per accident) <br /> AUTO ONLY-EA ACCIDENT S. <br /> 4GARAGELIABILITYOTHER.THANEA ACC S ANY AUTO AUTO ONLY: AGG S <br /> ESSIUMBRELLALIABIL�TY EACH OCCURRENCE $4,000,000 <br /> CUR CLAIMS MADE gXST0019'59 03/Q6/08 03/06/09 AGGREGATE $ 4;000;-000 <br /> Oc ❑ s <br /> DEDUCTIBLE <br /> RETENTION. $' <br /> X TORY LIMITS ( { ER <br /> N10RIZERS COMPENSATION AND <br /> D EMPLOYERS'.UABILITY 000713-4927-2008- . i 10/01/08 10/01/09 E.LEACHACCIDENT _ $ 1,000,000 <br /> ANY PROPR(ETOR/PARTNERIEXECUTIVE E.L.DISEASE-EA EMPLOYE $ 1,0 0 0,0 0 0 <br /> OFFICER/MEMBER EXCLUDED? <br /> If yea,describe under E.L DISEASE-POLICY LIMIT $ 1,000,000 <br /> SPECIAL_PROVISIONS t�elow <br /> --7 <br /> OTHER <br /> A { Pollution/�&0 FBC7001958 03/06/08 03/06/09 PO11/S&O 1,000,000 <br /> C ` Installation P'ltr 57MSIZ6050 03/06/08 03/06/09 Inst P'ltr 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT feSPZ1E�lAOf PROVISIONSremium. <br /> -1.0 days notice applies if cancelled for non-paym p <br /> CANCELLATION <br /> CERTIFICATE HOLDER <br /> TOV7HOMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLER BEFORE THE EXPIRATION <br /> DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL <br /> To Whom It Kay Concern IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> Dennis Cote, <br /> (Z ORD CORPORATION 1988 <br /> ACORD 25(2002!081 <br />
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