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COMPLIANCE INFO_2010-2012
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2300 - Underground Storage Tank Program
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PR0232355
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COMPLIANCE INFO_2010-2012
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Last modified
2/7/2024 4:20:47 PM
Creation date
6/23/2020 6:55:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2010-2012
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
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0232355_1721 S CHEROKEE_2010-2012.tif
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EHD - Public
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ACORD <br />CERTIFICAT F <br />LIABILITY INS R WALOP TO S <br />LTO -2 <br />DATE(MMIDD/YY <br />09/16/10 <br />PRODUCER <br />TLB Insurance <br />3000 Oak Rd., <br />Services <br />Suite 210 <br />DATE MM%DDS <br />03/06/11 <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 />ToRRENCE <br />PREMISES (Ea occurence) $ 50,000 <br />Walnut Creek CA 94597 <br />Phone: 925-395-2600 Fax:925-287-0710 <br />PERSONAL& ADV INJURY $ 1,000,000 <br />INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />��'`'(� <br />INSURER A. Endurance American spec Ins Co <br />INSURER B: Delos Insurance CO. <br />nrrnon rnPPOPATInN 14RR <br />C: SeaBright Insurance Co <br />Walton Engineering, Inc.INSURER <br />P.O. Box 1025 <br />West Sacramento CA 95691 <br />INSURER D: Hartford Insurance Co 34690 <br />INSURER E: <br />cUVtKAUtb <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 />LTR <br />A <br />NSR <br />TYPE OF INSURANCE <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE [K OCCUR <br />POLICY NUMBER <br />ECC101006001-01 <br />DATE MM/DDS E <br />03/06/10 <br />DATE MM%DDS <br />03/06/11 <br />LIMITS <br />$ 11000,000 <br />EACH OCCUGE_ <br />ToRRENCE <br />PREMISES (Ea occurence) $ 50,000 <br />MED EXP (Any one person) $ 5,000 <br />PERSONAL& ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />��'`'(� <br />Dennis Cote' <br />nrrnon rnPPOPATInN 14RR <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY X JCCT LOC <br />Em Ben. 1,000,000 <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />DPA5501792@2 <br />03/06/10 <br />03/06/11 <br />COMBINED SINGLE LIMIT $ 1,000,000 <br />(Ea accident) <br />ALL OWNED AUTOS <br />BODILY INJURY $ <br />(Per person) <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />BODILY INJURY $ <br />(Per accident) <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />AUTO ONLY: AGG $ <br />ANY AUTO <br />A <br />EXCESS/UMBRELLA LIABILITY <br />X OCCUR CLAIMS MADE <br />EXS101006002-01 <br />03/06/10 <br />03/06/11 <br />EACH OCCURRENCE $ 10, 000, 000 <br />AGGREGATE $ 10, 000, 000 <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />BB1103003 <br />10/01/10 <br />10/01/11 <br />X TORY LIMITS ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ 1,0001000 <br />E.L. DISEASE - POLICY LIMIT $ 1, 0 0 0 , 0 0 0 <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />OTHER <br />A <br />D <br />Pollution/E&O <br />I Installation Fltr <br />ECC101006001-01 <br />57MSIZ6050 <br />03/06/10 <br />03/06/10 <br />03/06/11 <br />03/06/11 <br />Poll/E&O 11000,000 <br />Inst Fltr 2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. <br />GERTIFIGA It HULUMM- <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />TOWHOMI <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 May Concern <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTAT <br />��'`'(� <br />Dennis Cote' <br />nrrnon rnPPOPATInN 14RR <br />ACORD 25 (2001/08) <br />
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