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COMPLIANCE INFO_2014-2015
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0505264
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COMPLIANCE INFO_2014-2015
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Entry Properties
Last modified
8/4/2021 4:36:01 PM
Creation date
6/23/2020 6:57:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2014-2015
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
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0505264_1501 N JACK TONE_2014-2015.tif
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EHD - Public
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JONECOV-02 DADACAYA <br /> DATE(MMIDDIYYYY) <br /> CER CATS OF LIABILITY INSUFMCE 1 6/30/2014 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsements . <br /> PRODUCER License#1 OE67768 NAME CT Elizabeth Lisek <br /> IOA Insurance Services-ORG PHONE 949 297-5962 AX(AIC No; 949)297-5960 <br /> 130 Vantis,Suite 250 EMAIL <br /> Allso Viejo,CA 92656 ADDRESS:elizabeth.lisek@ioausa.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Homeland Insurance Company Of New York 34452 <br /> INSURED INSURER B:EMC Property&Casualty Company 25186 <br /> Jones Covey Group,Inc. INSURER C:Everest National Insurance Company 10120 <br /> 9595 Lucas Ranch Rd Ste 100 INSURER D: <br /> Rancho Cucamonga,CA 91730 INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> fLT R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF <br /> POLICY EXP LIMITS <br /> LTR <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,00 <br /> CLAIMS-MADE ®OCCUR 7930001440003 07101/2014 07/01/2015 PREMISES Ea GE TO RENTED occurrence) $ 50,00 <br /> MED EXP(Agy one person) $ 5,00 <br /> PERSONAL&ADV INJURY $ 5,000,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,00 <br /> PPOLICY®JEC ❑LOC PRODUCTS-COMPIOPAGG $ 5,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000,000 <br /> £a acadent , <br /> B X ANY AUTO 5E15054 07/01/2014 0710112015 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> HIRED AUTOS <br /> NON-OWNED PeOacEcIde DAMAGE $ <br /> $ <br /> UMBRELLA LIARX OCCUR EACH OCCURRENCE $ 2,000,000 <br /> A X EXCESS LIAB CLAIMS-MADE 7930001450003 07101/2014 0710112015 AGGREGATE $ 2,000,00 <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION 7( <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> C ANY PROPMETORIPARTNEWEXECUTIVE YIN NIA CA10002046141 05/01/2014 0510112015 E.L.EACH ACCIDENT $ 1,000,00 <br /> OFFICERIMEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 <br /> Ifes,describe under <br /> DrSCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> A Professional Liab. 7930001440003 07/01/2014 07101/2015 1-imit: 5,000,00 <br /> A Pollution Llab. 7930001440003 07/01/2014 07101/2015 Limit: 5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> Re:Evidence of Insurance <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Jones Covey Group.Inc. AUTHORIZED REPRESENTATIVE <br /> 9595 Lucas Ranch Rd �'/G � <br /> Suite 100 �� f r C21 c <br /> Rancho Cucamonga,CA 91730 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />
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