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WP0041687
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041687
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Entry Properties
Last modified
3/19/2021 9:48:38 AM
Creation date
3/19/2021 9:43:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041687
PE
4371
STREET_NUMBER
0
STREET_NAME
INGLEWOOD
STREET_TYPE
AVE
City
STOCKTON
Zip
95207-
APN
08114013 (NEAR)
ENTERED_DATE
2/5/2021 12:00:00 AM
SITE_LOCATION
0 INGLEWOOD AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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Attachment Code:D545188 Certificate ID: 15495702 <br /> Workers'Compensation and Employers' Liability Policy <br /> Named Insured Endorsement Number <br /> AEGION CORPORATION <br /> 1798S EDISON AVE Policy Number <br /> CHESTERFIELD MO 63005 Symbol:WLR Number.WLRC67457262 CA/MA <br /> Policy Period Effective Date of Endorsement <br /> 7/112020 TO 7/1/2021 07-01-2019 <br /> Issued By(Name of Insurance Company) <br /> ACE AMERICAN INSURANCE COMPANY <br /> Insert the policy number.The remainder of the Information Is to be completed only when this endorsement Is Issued subsequent to the preparation of the <br /> policy. <br /> CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of <br /> the Information Page. <br /> We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not <br /> enforce our right against the person or organization named in the Schedule, but this waiver applies only with <br /> respect to bodily injury arising out of the operations described in the Schedule, where you are required by a <br /> written contract to obtain this waiver from us. <br /> You must maintain payroll records accurately segregating the remuneration of your employees while engaged in <br /> the work described in the Schedule. <br /> Schedule <br /> 1. ( ) Specific Waiver <br /> Name of person or organization: <br /> (X) Blanket Waiver <br /> Any person or organization for whom the Named Insured has agreed by written contract to furnish this <br /> waiver. <br /> 2. Operations: <br /> ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH <br /> WRITTEN CONTRACT <br /> 1 <br /> I <br /> i <br /> 3. Premium: <br /> The premium charge for this endorsement shall be 2.0 percent of the California premium developed I <br /> on payroll In connection with work performed`for the above person(s)or organization(s) arising out of 1 <br /> the operations described. I <br /> 4. Minimum Premium: $0 <br /> f <br /> Authorized Representative <br /> i WC 90 03 75(05/18) <br />
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