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COMPLIANCE INFO_2005-2009
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2300 - Underground Storage Tank Program
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PR0232355
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COMPLIANCE INFO_2005-2009
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Last modified
2/7/2024 4:16:46 PM
Creation date
6/23/2020 6:55:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2005-2009
RECORD_ID
PR0232355
PE
2361
FACILITY_ID
FA0000591
FACILITY_NAME
QUIK STOP MARKET #2152
STREET_NUMBER
1721
Direction
S
STREET_NAME
CHEROKEE
STREET_TYPE
LN
City
LODI
Zip
95240
APN
062-060-48
CURRENT_STATUS
01
SITE_LOCATION
1721 S CHEROKEE LN # 1
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0232355_1721 S CHEROKEE_2005-2009.tif
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EHD - Public
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OP ID S <br />ACOMM`_ CERTIFICATE OF LIABILITY INSURANCE WALTO-2 <br />DATE (MMUDDJYYYY) <br />03/66/08 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON .THE CERTIFICATE <br />TLB Insurance Services <br />3 00 0- Oak Rd., Suite 210 <br />HOLDER. CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIL# <br />Walnut Creek.CA 94597 <br />phone: 925-395-2600 Fax. -925-287 -0710 <br />INSURED <br />INSURER . Hudson Insurance Company <br />INSURER B: Delos insurance Co.. <br />- <br />INSURERC: Hartfotd Insurance Co. 34690 <br />Walton Engineering, Inc. <br />''P.O. SOX 1025 <br />West Sacramento CA 95691 <br />INSURER D: state Compensationzasurance <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 MAYBE 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 LIMI TS ..... ltiL4Y H 4VE' SEEN' REDUCED BY PAID CLAIMS. <br />LTR <br />NSR <br />TYPE OF INSURANCE <br />POUCY NUMBER <br />DATE MM10 <br />EXPIRATION <br />DATE MMUD <br />LIMITS <br />GENERAL LIABILITY <br />EACHOCCURRENCE$1,000,000 <br />PREMISES $50,000 <br />A <br />X COMMERCIAL GENERAL UABILITY <br />CLAIMS MADE ® OCCUR <br />PEC7001958 <br />03/06/08 <br />03/06/09 <br />MED EXP (Any one P -n- i$5 000/" <br />PERSONAL &ADV INJURY $1,000400'• <br />GENERAL AGGREGATE s2,000,000 <br />GEWL AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG s2,000,000 <br />Elft Ben. 11000,000 <br />POLICY Fx JEC LOC <br />B <br />AUTOMOBILE <br />LABILITY <br />ANY AUTO <br />DPA5501792 <br />03/06/08 <br />03/06/09 <br />COMBINED SINGLE LIMIT $ 1 y 000,000 <br />(Ea accident) <br />X <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY $ <br />(Per person) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />BODILY INJURY $ <br />(Per accident) <br />"PROPERTYDAMAGE <br />$ <br />(Per accident) <br />GARAGE LIABIUTY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC - $ <br />AUTO ONLY: AGG $ <br />ANY AUTO <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE s4,000,000 <br />.AGGREGATE s4,000,000 <br />A <br />X OCCUR CLAIMS MADE <br />FXS7001959 <br />03/06/08 <br />03/06/04 <br />$ <br />$ <br />DEDUCTIBLE <br />I $ <br />RETENTION $ <br />( <br />WORKERS COMPENSATION AND' <br />X TORY 11MITS ER <br />E.L.EACHACCIDENT .; $ 1,000,000 <br />D <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERNEMBER EXCLUDED? <br />7130004927-07 <br />10/01/07 <br />10/01/08 <br />E.L. DISEASE - EA EMPLO E $1,000,000 <br />E.L. DISEASE -POLICY LIMIT $1,000,000 . <br />s describe tmdrx <br />SPECIAL. PROVISIONS Below <br />--- <br />OTHER <br />A <br />C <br />Pollution/S&O <br />Installation Fltr <br />FEC7001958 <br />57MSIZ6050 <br />03/06/08 <br />03/06/08. <br />03/06/09 <br />03/06/09 <br />Poll/E&O 11000,000 <br />Inst Fltr 1,000,600 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for noxi'. -payment of premium. <br />CANCELLATION <br />TOWFiOM2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVORTO MAIL 30* DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO LEFT, BUT FAILURE TO DO SO SHALL <br />TO WtlOm It May COACern IMPOSE NO OBLIGATION OR LIABILITY F ANY KIaPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE d <br />Dennis Cote' - <br />ACORD<25 (2009108) _ 0 ACORD CORPORATION 1988. <br />
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