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COMPLIANCE INFO_2018-2019
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0505264
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COMPLIANCE INFO_2018-2019
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Entry Properties
Last modified
8/11/2021 9:05:40 AM
Creation date
6/23/2020 6:57:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2018-2019
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_2018-2019.tif
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EHD - Public
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JONECOV-02 DADACAYA <br /> CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) <br /> 4/127/227/2018 <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER License#OE67768 CONTACT Stacy Ownbey <br /> IOA Insurance Services PHONE FAx <br /> 130 Vantis (A/C,No,Ext):(949)297-5962 (A/C No):(949)297-5960 <br /> Suite 250 EDDRIESS:Stacy.Ownbey@ioausa.com <br /> Aliso Viejo,CA 92656 <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Colony Insurance Company 39993 <br /> INSURED INSURER 13:Philadelphia Indemnity Insurance Company 18058 <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 <br /> 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 /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 <br /> CLAIMS-MADE ®OCCUR PACE306425 07/01/2017 07/01/2018 DAMAGE TO RENTED 500,000 <br /> PREMISES Ea occurrence $ <br /> MED EXP(Any oneperson) $ 25'000 <br /> PERSONAL&ADV INJURY $ 5'000,000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5'000,000 <br /> POLICY I JECT LOC PRODUCTS-COMP/OP AGG $ 5'000'000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 <br /> Ea accident $ <br /> X ANY AUTO PHPK1678139 07/01/2017 07/01/2018 BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> HIRED NON-OWNED PROPERTYAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident $ <br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6'000'000 <br /> X EXCESS LIAB CLAIMS-MADE EXC305426 07/01/2017 07/01/2018 AGGREGATE $ 6'000'000 <br /> DED I X I RETENTION$ 0 $ <br /> C WORKERS COMPENSATIONPER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N X TAT TE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE CA10002046181 05/01/2018 05/01/2019 E.L.EACH ACCIDENT $ 1'000'000 <br /> OFFICER/MEMBER EXCLUDED? � N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Professional Liab PACE305425 07/01/2017 07/01/2018 5,000,000 <br /> A Contractors Poll PACE305425 07/01/2017 07/01/2018 5,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Proof of Coverage. <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 /> AUTHORIZED REPRESENTATIVE <br /> Jones Covey Group.Inc. <br /> 9595 Lucas Ranch Rd,Suite 100 <br /> IRancho Cucamonaa.CA 91730 <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
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