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COMPLIANCE INFO_2009-2012
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2300 - Underground Storage Tank Program
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PR0507204
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COMPLIANCE INFO_2009-2012
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Last modified
2/29/2024 11:25:26 AM
Creation date
6/23/2020 6:58:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2009-2012
RECORD_ID
PR0507204
PE
2361
FACILITY_ID
FA0007735
FACILITY_NAME
7-ELEVEN INC #32262
STREET_NUMBER
2360
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
23819001
CURRENT_STATUS
01
SITE_LOCATION
2360 W GRANT LINE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0507204_2360 W GRANT LINE_2009-2012.tif
Tags
EHD - Public
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ACORD CE TIFIC T F LIABILITY I N 3 <br />WALTOLTO-2 <br />DATE,MM,DOnYYY, <br />.09 25 08 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />TLB Insurance Services <br />3000 Oak Rd., Suite 210 <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />POLICY EXPIRATION <br />DATE MM/DD/YY <br />Walnut Creek CA 94597 <br />Phone: 925-395-2600 1Pax : 92 5 - 2 87 - 0 710 <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED <br />INSURER A: . Hudson Insurance Company <br />INSURERB: Delos Insurance Co. <br />Dennis Cote <br />�.,�u •nee <br />INSURER C: Hartford Insurance Co 34690 <br />Walton Engineering, Inc. <br />INSURER D: state compensation Zasurance <br />West Sacramento CA 95691 <br />INSURER E: <br />VVYGnMVG.7 <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 />NUR LTR <br />VU <br />NS <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />FECTIVE <br />DATE MM/OD <br />POLICY EXPIRATION <br />DATE MM/DD/YY <br />LIMITS <br />REPRESENTATIVES. <br />GENERAL LIABILITY <br />AUTHORIZED REPRESENTATIVE <br />Dennis Cote <br />�.,�u •nee <br />EACH OCCURRENCE $ 1,000,000 <br />PREMISES (Ea occure�— $ 50,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE ®OCCUR <br />FEC7001958 <br />03/06/08 <br />03/06/09 <br />MED EXP (Any one person) $ 5,000 <br />PERSONAL BADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE s2,000,000 <br />GEML AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG s2,000,000 <br />Emp Ben. 11000,000 <br />POLICY X PR LOC <br />JECT <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />DPA5 5 017 92 <br />03/66/08 <br />03%06/09 <br />COMBINED SINGLE LIMIT $ 1,000,0.00 <br />(Ea accident) <br />BODILY INJURY $ <br />(Per person) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />BODILY INJURY $ <br />(Per accident) <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 />EXCESSIUMBRELLALIABILITY <br />EACH OCCURRENCE s4,000,000 <br />AGGREGATE $4yOMOOO <br />A <br />X- OCCUR CLAIMSMADE <br />FXS7001959 <br />03/06/08 <br />03/06/09 <br />$ <br />$ <br />DEDUCTIBLE <br />$ .. <br />_ ... <br />_.......RETENTION. - .$ <br />_ ...... ............_ ........_..... ...._... <br />....... <br />WORKERS COMPENSATION AND <br />X I TORY LIMITSI I ER <br />E.L. EACH ACCIDENT $ 1,.000,000 <br />D <br />EMPLOYERS LIABILITY <br />ANY PROPRIETORIPARTNER/EXECUTIVE <br />OFFICER/MEMBEREXCLUDED? <br />000713-4927-2008. <br />10/01/08 <br />10/01/09 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />if yes; describe under <br />SPECIAL PROVISIONS below <br />OTHER. .:. ., <br />A <br />C <br />Pollution/E&O <br />I Installation Fltr <br />FEC7001958 <br />57MSIZ6050 <br />03/06/08 <br />03/06/08 <br />03/06/09 <br />03/06/09 <br />Poll/E&O 11000,000 <br />Inst Fltr 11000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. <br />n L--- INn •T1= U^1 n1=0 GANGt=LLA 11U1V <br />TOWHOMI <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 />To Whom It May Concern <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />Dennis Cote <br />�.,�u •nee <br />ACORD 26 (2001108) vnwnv 1Y <br />
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