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WP0041565
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041565
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Entry Properties
Last modified
6/7/2021 2:55:23 PM
Creation date
6/7/2021 2:53:07 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041565
PE
4372
STREET_NUMBER
16775
Direction
S
STREET_NAME
HOWLAND
STREET_TYPE
RD
City
LATHROP
Zip
95330-
APN
19814004
ENTERED_DATE
12/29/2020 12:00:00 AM
SITE_LOCATION
16775 S HOWLAND RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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Page 1 of 1 <br />•O iiQ0 DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE 12/21/2020 <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 BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the V(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Willis Towers Watson Midwest, Inc. <br />c/o 26 Century Blvd <br />P.O. Box 305191 <br />Nashville, TN 372305191 USA <br />INSURED <br />Conetec, Inc. <br />820 Aladdin Ave <br />San Leandro, CA 94577 <br />COVERAGES <br />CERTIFICATE NUMBER: w19424s3s <br />Willis Towers Watson Certificate Center <br />1-877-945-7378 <br />certificates@willis.com <br />1-888-467-2378 <br />INSURERA: <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />American Zurich <br />Insurance <br />Company <br />TYPE OF INSURANCE <br />40142 <br />INSURERB: <br />POLICY NUMBER <br />Zurich American <br />Insurance <br />Company <br />16535 <br />INSURERC: <br />National Fire & <br />Marine Insurance Company <br />20079 <br />D: <br />INSURER E <br />INSURER F <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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />IND <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY EXP <br />MM/DD/YYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />EACH OCCURRENCE <br />$ 2 , 000 , 000 <br />DAMAGE(RENTED <br />PREMISESS <br />PREMIEa occurrence <br />$ 300,000 <br />A <br />MED EXP (Any one person) <br />$ 15 , 000 <br />Y <br />GLOO184640-05 <br />10/01/2020 <br />10/01/2021 <br />PERSONAL &ADV INJURY <br />$ 21000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PE� F—]LOCPRODUCTS <br />I GENERAL AGGREGATE <br />$ 4 , 000 , 000 <br />- COMP/OP AGG <br />$ 41000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 21000,000 <br />)( <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />B <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BA 0184641-05 <br />10/01/2020 <br />10/01/2021 <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED <br />RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOR/PARTNER/EXECUTIVE FN <br />OFFICER/MEMBEREXCLUE No <br />(Mandatory in NH) <br />N/A <br />WC0184642-05 <br />10/01/2020 <br />10/01/2021 <br />x <br />PER <br />STATUTE <br />OTH- <br />ER <br />E.L. EACH ACCIDENT <br />$ 170001000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 11000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />11000,000 <br />$ <br />C <br />Pollution Liability <br />42 -CPL -308939-02 <br />10/01/2020 <br />10/01/2021 <br />Per Incident <br />$2,000,000 <br />Aggregate <br />$2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />San Joaquin County Environmental Health Department is included as an Additional Insured as respects to General <br />Liability, <br />CERTIFICATE HOLDER CANCELLATION <br />©1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />and logo are <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />San Joaquin County Environmental Health Department <br />armcx: 1922640 <br />AUTHORIZED REPRESENTATIVE <br />1868 East Hazel Avenue <br />Stockton, CA 95205-6232 <br />C1 , �✓ <br />©1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) <br />The ACORD name <br />and logo are <br />registered marks of ACORD <br />SR ID: <br />20486722 <br />armcx: 1922640 <br />
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