COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

State of California—Califohria Environmental Protection Agency Department of Toxic Substances Control Transportation Unit 8800 Cal Center Drive Sacramento,CA 95826-3200 Phone(916)440-7145 Fax (916)255-6436 CERTIFICATE OF INSURANCE FOR PUBLIC LIABILITY COVERAGE NAME OF INSURED: jt�FlESS: PHONE NUMBER: RB Environmental,Inc. S.Highway 99,Stockton,CA 95215 209)932-MM CERTIFICATION I The authorized signature below certifies that: (a)each policy of insurance listed below has been issued to the insured named above and is In force at this time and(b)each policy so listed PROVIDES VEHICLE LIABILITY COVERAGE FOR"PUBLIC LIABILITY" WHICH INCLUDES LIABILITY FOR"BODILY INJURY,""PROPERTY DAMAGE"AND"ENVIRONMENTAL RESTORATION" PURSUANT TO SECTION 25169 OF THE CALIFORNIA HEALTH AND SAFETY CODE with respect to the operation,maintenance or use by the named insured of any vehicle for which registration or authorization to transport hazardous waste is required by the Department of Toxic Substances Control of the State of California regardless of whether such vehides are specifically described in the policy. PRIMARY INSURANCE—COMBINED SINGLE LIMIT EFFECTIVE DATE OF INSURANCE POLICY NUMBER: EF2CA00019-191 COVERAGE: 12124@019 INSURANCE COMPANY NAME: ADDRESS: TELEPHONE NUMBER: Everest National Insurance Company P.O.Bot 830 Liberty Comer,NJ 07938 ( 908) 804-300D This policy provides coverage for public liability including bodily injury,property damage and environmental restoration for the amount of$ 1-000,000 in accordance with language consistent with a MCS-90 endorsement EXCESS LIABILITY INSURANCE EFFECTIVE DATE OF INSURANCE POLICY NUMBER: COVERAGE: INSURANCE COMPANY NAME: ADDRESS: TELEPHONE NUMBER: 7 This policy provides coverage for amounts in excess of the primary insurance for public liability including bodily injury,property damage and environmental restoration for the amount of$ in accordance with language consistent with a MCS-90 endorsement CANCELLATION ENDORSEMENT The authorized signature beknn warrants and guarantees that each insurance policy for which this Certificate of Insurance is issued is effective until canceled or expired;and,such policy coverage shall remain in full force and effect until the thirtieth(30')day after a Notice of Cancellation in writing is given on behalf of the Insurance Company to the Department of Toxic Substances Control. The thirty(30)day period is to commence from the date the Notice of Cancellation is provided to the Department of Toxic Substances Control,Transportation Unit This Certificate of Insurance and any Notice of Cancellation are properly filed by mailing,postage paid,to the Department of Toxic Substances Control,Transportation Unit,8800 Cal Center Drive,Sacramento,California 95826-3200. AUTHORIZED SIGNATURE I HEREBY CERTIFY under penalty of law that: (a)all information provided is true and correct,and(b)either the Insurance Company is admitted by the Department of Insurance in the State of California to write the listed insurance policies OR,if not admitted,I am licensed by the California Department of Insurance as a"Surplus Lines Broker"authorized to represent the named Insurance Company in making this certification. AUTHORIZED SIGNAT (Signature' ra Ing color ink) DATE SIGNED: - 01/0312020 NAME AND TITLE:(Please print or type) SURPLUS LINES BROKER NO.(If applicable): Thomas P.Jones 0715034 COMPANY NAME: SIGNER'S COMPANY ADDRESS: TELEPHONE NUMBER: Crouse&Associates Insurance Services of Northern 630 California SL,ft2900 San Francisco,CA (415) 982-3870 California 94108 (DEFINITIONS USED IN THIS CERTIFICATE OF INSURANCE ARE SHOWN ON THE REVERSE SIDE OF THIS FORM.) DTSC 8038[front](7109)