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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
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FilePath
\MIGRATIONS\UST\UST_2361_PR0232355_1721 S CHEROKEE_2010-2012.tif
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EHD - Public
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ACORDa CE <br />RTIFICATE QF LIABILITY INSURANCE <br />PRODUCER Op Ip SF DATE (!d M/DD;'Yl'YY) <br />F7P.LTO-2 09 29 09 <br />TRIS CERTIr"ICATE IS ISSUED AS A h1ATTER OF INFORMATION <br />T:,B Insurance Services ONLY ANp CONFERS NO RIGHTS UPON THE CERTIFICATE <br />3 0 0 u Oak Rd . , Suite 21 G HOLDER. THIS CERTIFICATE DOES NOT Ah1END, EXTEN DOR <br />E4alnut Creek CA 9 g 5 g7 I ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />One: 925-395-2600 B FLOW, <br />rax:925-287-0710 <br />INSURED -.-. <br />'Halton Engineering, Inc, <br />Weet Saccramento CA 95691 <br />INSURERS AFFORDING COVERAGE <br />INSURER A: SeaBri ? NAIC # <br />g• t Insurance Co <br />I INSURER B: _ <br />INSURER C: <br />I INSURER D: -- <br />COVERAGES i 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 REQUIRE.4ENT. TERM OR CON DITION 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 LI.'AITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />qSR AUY <br />-TR INSRO TYPE OF INSURANCE POLICY NUNIBER POU Y EF EC I E iPnl Ir <br />i GENERAL LIABILITY <br />I 'OMNERCIAL GENERAL LIABILITY <br />' CLAIMS MADE OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />—i <br />(�l PRO - <br />POLICY I I JECT [71 LOC <br />AUTOMOBILE LIABILITY <br />ANYAUTO <br />ALL OWNED AUTOS <br />SCHEOULEDAUTOS j <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />GARAGE LIABILITY <br />I ANY AUTO <br />I EXCESS/UtABRELLA LIABILITY i <br />OCCUR CLAIMS MADE 1 <br />{ DF.DUCTBLE � <br />I RETENTION S I <br />' WORKERS COMPENSATION AND ' <br />A I EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/ PARTNER/EXECUTIVE I BB 10 9 3 0 0 3 <br />I OFFICER/MEMBER EXCLUDED? <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />- LIMITS <br />EACH OCCURRENCE c I PREMISES (Ea occurence) S <br />I MED EXP (Any one person) ' S <br />PERSONAL & ADV INJURY $ <br />GENERALAGGREGATE g <br />PRODUCTS - COMP/OP AGG g <br />COMBINED SINGLE LIMIT <br />(Ea accidenq S <br />I I <br />I BODILY INJURY <br />j (Per person) S <br />i ) <br />BODILY INJURY <br />I (Per accident) S <br />1 PROPERTY DAMAGE <br />j (Per accident) S <br />j i I AUTO ONLY - EA ACCIDENT S <br />OTHER THAN EA ACC S <br />AUTO ONLY: <br />AGG S <br />EACH OCCURRENCE S <br />I AGGREGATE <br />S <br />e j S <br />10/01/0910/01/10. "m"' ; ER I <br />I E.L. EACH ACCIDENT ' S 1,000,000 <br />L DISEASE • EA EMPLOYEEI S 1,000,000 <br />E.L. DISEASE - POLICY LIMIT 000,000 <br />1escRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non - <br />insurance only. PaYmert of premiu.,n <br />CERTIFICATE HOLDFR <br />TOWHOMI <br />To Whom It May Concern <br />ACORD 95I9nnimm <br />Evidence of <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POL;CiES BE CANCELLED BEFORE TH E EXPIRATIO <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO D O SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AG ENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTALiLJE� <br />Dennis Cote '/ <br />©ACORD CORPORATION 1988 <br />
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