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WP0041563
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041563
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Last modified
3/4/2021 1:12:32 PM
Creation date
3/4/2021 12:22:30 PM
Metadata
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Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041563
PE
4372
STREET_NUMBER
1780
STREET_NAME
WHIRLAWAY
STREET_TYPE
LN
City
TRACY
Zip
95376-
APN
24402040
ENTERED_DATE
12/29/2020 12:00:00 AM
SITE_LOCATION
1780 WHIRLAWAY LN
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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SJGOV\tsok
Tags
EHD - Public
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STATE ENDORSEMENT AGREEMENT BROKER COPY <br /> WAIVER OF SUBROGATION REP 04 <br /> INSURANCE BLANKET BASIS 9230422-20 <br /> FUND RENEWAL <br /> NE <br /> HOME OFFICE 2-70- - <br /> SAN FRANCISCO EFFECTIVE MAY 1, 2020 AT 12.01 A.M. PAGE 1 OF 1 <br /> ALL EFFECTIVE DATES ARE AND EXPIRING MAY 1, 2021 AT 12.01 A.M. <br /> AT 12:01 AM PACIFIC <br /> STANDARD TIME OR THE <br /> TIME INDICATED AT <br /> PACIFIC STANDARD TIME <br /> MOORE TWINING ASSOCIATES, INC. <br /> PO BOX 1472 <br /> FRESNO, CA 93716 <br /> WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE <br /> LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL <br /> NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR <br /> ORGANIZATION NAMED IN THE SCHEDULE. <br /> THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU <br /> PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU <br /> TO OBTAIN THIS AGREEMENT FROM US. <br /> THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE <br /> 2.00% OF THE TOTAL POLICY PREMIUM. <br /> SCHEDULE <br /> PERSON OR ORGANIZATION JOB DESCRIPTION <br /> ANY PERSON OR ORGANIZATION BLANKET WAIVER OF <br /> FOR WHOM THE NAMED INSURED SUBROGATION <br /> HAS AGREED BY WRITTEN <br /> CONTRACT TO FURNISH THIS <br /> WAIVER <br /> NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE <br /> OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS <br /> POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br /> HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br /> LIMITATIONS OF THIS ENDORSEMENT. <br /> COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: APRIL 20, 2020 <br /> 2572 <br /> AUTHORIZED REPRESENT IVE PRESIDENT AND CEO <br /> SCIF FORM 10217 (REV.7.2014) OLD DP 217 <br />
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