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COMPLIANCE INFO_2008
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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JACK TONE
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2300 - Underground Storage Tank Program
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PR0505264
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COMPLIANCE INFO_2008
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Last modified
7/28/2021 1:45:25 PM
Creation date
6/23/2020 6:57:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2008
RECORD_ID
PR0505264
PE
2361
FACILITY_ID
FA0006672
FACILITY_NAME
FLYING J TRAVEL PLAZA #618*
STREET_NUMBER
1501
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
22811017
CURRENT_STATUS
01
SITE_LOCATION
1501 N JACK TONE RD
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
Scanner
KBlackwell
Supplemental fields
FilePath
\MIGRATIONS\J\JACK TONE\1501\PR0505264\FINAL JUDGMENT ON CONSENT 09-29-08.PDF
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EHD - Public
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I�1 Cs LiL71� 'r'{J LIABILITY ' OF ID C1 DATE(MMIODJYYYY} <br /> SERttIO1 06/03/08 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> George Petersen Ins Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> P. 0. Box 3539 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 627 College Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Santa Rosa CA 95402 <br /> Phone: 7D7-525-4150 Fax:707-525-4175 INSURERS AFFORDING COVERAGE NAIC0 <br /> ltasuREO INSURER A ress Insurance Compan <br /> INSURER 8: <br /> Service Station Systems, Inc. INSURER C: <br /> 680 013inn Avenue INSURER 0: <br /> San Jose CA 95112 <br /> 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 REOUIREMENT,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 /> PO C- F€CT E�POLTC TON <br /> 1N � ff <br /> LTR NSR TYPE OF INSURANCE POUCY NUMBER DATE IMMMDIYYI DATE MMIDLIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE 3 <br /> COMMERCIAL GENERAL LIABILITY PREMISES jEa o=rance) S <br /> CLAIMS MADE E OCCUR MED EXP(Any one person) S <br /> PERSONAL&ADV INJURY S <br /> GENERAL AGGREGATE S <br /> GERL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S <br /> POLICYF—j JECT LOC <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) S <br /> ALL OWNED AUTOS <br /> BODILY INJURY 5 <br /> SCHEDULED AUTOS (Per Person) <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE S <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S <br /> ANY AUTO EA RCC $OTHER THAN _.._, <br /> AUTO ONLY. AGG S <br /> EXCESSAIMBRELLA LIABILITY I EACH OCCURRENCE S <br /> OCCUR ❑ CLAIMS MADE ' AGGREGATE s <br /> S <br /> DEDUCTIBLE <br /> 3 <br /> RETENTION S g <br /> IAII <br /> WORKERS COMPENSATION AND X TORY LIMITS <br /> ER <br /> EMPLOYERS'LIABILITY <br /> A 33 .0020636081 06/04/08 06/04/09 E.L.EACH ACCIDENT 51000000 <br /> ANY PROPRIETOWPARTNERIEXECUTIVE <br /> OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EAEMPLOYEE 51000000 <br /> If s,deribe under <br /> SPECALPROVISIONSbelow E.L.DISEASE-POLICY LIMIT $1000000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> Re: License #485184 <br /> Evidence of Workers' Compensation Coverage. <br /> Ten Day Notice of Cancellation in the event of non-payment of premium. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 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 /> Contractors State License Boar IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> PO Box 26000 REPRESENTATIVES. <br /> Sacramento CA 95826 A=REFr <br /> ACORD 25(2001108) ©ACORD CORPORATION 1988 <br />
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