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COMPLIANCE INFO_2021
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2300 - Underground Storage Tank Program
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PR0506504
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
1/11/2022 3:43:35 PM
Creation date
3/5/2021 2:12:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0506504
PE
2361
FACILITY_ID
FA0007464
FACILITY_NAME
MAIN STREET ARCO AM PM*
STREET_NUMBER
1100
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95337
APN
22119062
CURRENT_STATUS
01
SITE_LOCATION
1100 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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DIAMO 4 OP ID: AS <br /> ACOR©" DATE (MMIDDNYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 11 /042020 <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 ' SY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 endorsement (s). <br /> PRODUCER NAME P.J. Chawla <br /> Peck & Peck Insurance Brokers PHO650�92a591 No : 65O-592-0404 <br /> 1724 Laurel Strest Sulte 225 <br /> San Carlos, CA 94070 Ate ; MYBROKER USA.COM <br /> P.J. Chawia <br /> wsuafa:(sl AFFORDING COVERAGE NAIc t< <br /> INSURER A : Mesa Underwriters Specialty <br /> INSURED Diamond Petroleum Services Inc INSURER B : State Compensation Ins Fund 35076 <br /> Guadalupe Sanchez INSURER C : <br /> 3619 King Rd <br /> Antioch , CA 94509 INSURERD : <br /> INSURER E <br /> INSURER F : Eli <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 /> TS41 TYPE OF INSURANCE ADM 3U5H POLICY EFF POLICY EXP POLICY NUMBER MMIDD MMIDDNM , LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 ;000,00 <br /> cLaMSMaoE D OCCUR P0002008001026 09109/2020 09/09/2021 PREMISES EeoccurreRENEunce $ 100000 <br /> MED EXP (Any one person) $ $600 <br /> PERSONAL & ADV INJURY S 1 ,000100 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4 2,000,00 <br /> X POLICY F ] PRI F�l LOC PRODUCTS- COMP/OP AGG $ 2,0001OO <br /> JECT <br /> OTHER: S <br /> AUTDMOSILELIABILITY COMBINED ) LIMIT <br /> S <br /> Ea accident <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> AUTOS OWNED SCHEAUTODULED BODILY INJURY (Per accident) S <br /> NON•OWNED PeOracECRidenDAMAGE $ <br /> HIRED AUTOS AUTOS <br /> S <br /> UMBRELLA LAB OCCUR EACH OCCURRENCE S <br /> EXCESS LAB CLAIMS•MADE AGGREGATE S <br /> DED RETENTION S S <br /> WORKERS COMPENSATION X STEARTUTE I ER <br /> AND EMPLOYERS• LIABILITY <br /> B ANY PROPRIETORIPARTNER/ExECUTIVE YIN NIA 214798-20 07/21 /2020 07/21 /2027 E.L. EACH ACCIDENT _ It _ 1 ,000,00 <br /> 014 <br /> OFFICERMEMBER EXiCLUDED9 <br /> (Mandatory in NH) E.L. DISEASE . EA EMPLOYEE S 1 +000,00 <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT S 1 ,000,00 <br /> A roperty Coverage P0002008001026 09/0912020 09/0912021 10,00 <br /> I <br /> r <br /> 4 <br /> DESCRIPTION OF OPERAVONSI LOCATIONS I VEHICLES (ACORD 101 , Addltlonat Remarlts SehedWe, maybe attached lf more space is Mqutred) <br /> i <br /> Proof of Insurance Only. <br /> i <br /> CERTIFICATE HOLDER CANCELLATION <br /> BLANK4 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPD2ATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> *"Proof of Insurance"*" <br /> AUTHORIZED REPRESENTATIVE <br /> O 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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