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REMOVAL_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HOLLY
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2300 - Underground Storage Tank Program
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PR0502021
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REMOVAL_2021
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Entry Properties
Last modified
9/14/2021 11:41:38 AM
Creation date
6/9/2021 3:39:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2021
RECORD_ID
PR0502021
PE
2361
FACILITY_ID
FA0005302
FACILITY_NAME
SPRECKELS SUGAR COMPANY
STREET_NUMBER
20500
STREET_NAME
HOLLY
STREET_TYPE
DR
City
TRACY
Zip
95304
APN
21216010
CURRENT_STATUS
02
SITE_LOCATION
20500 HOLLY DR
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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�o CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDD/YYYY) <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 policy(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 Risk Strategies Company <br />2040 Main Street, Suite 450 <br />Irvine, CA 92614 <br />www. risk-strategies.com <br />CA DOI License No. OF06675 <br />INSURED <br />Costera Waste & Environmental <br />14 EI Vaquero <br />Rancho Santa Margarita CA 92688 <br />rnv�enr_Gc <br />r'FRTIFI(:ATF (VIIMRFR• r.O�r,�Fn7 <br />AFFORDING COVERAGE <br />ty Insurance Co <br />Insurance Fund <br />v 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 />A <br />TYPE OF INSURANCE <br />�/ COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE IV/] OCCUR <br />ADDL <br />SUBR <br />POLICY NUMBER <br />PPK2200038 <br />POLICY EFF <br />MM/DDfYYYY <br />10/28/2020 <br />POLICY EXP <br />MM/DD/YYYY <br />10/28/2021 <br />LIMITS <br />EACH OCCURRENCE <br />$1,000,000 <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />$1001000 <br />MED EXP (Any one person) <br />$ 10,000 <br />PERSONAL& ADV INJURY <br />$19000,000 <br />GENERAL AGGREGATE <br />$23000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ✓l JECT [7] LOC <br />OTHER: <br />PRODUCTS -COMP/OP AGG <br />$2,000,000 <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />I L <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />1 <br />$ <br />A <br />FB <br />UMBRELLALIAB <br />EXCESS LIAB <br />�/ <br />OCCUR <br />CLAIMS -MADE <br />PUB745709 <br />11/6/2020 <br />10/28/2021 <br />EACH OCCURRENCE <br />$$5000000 <br />AGGREGATE <br />$$50000,000 <br />$ <br />DED <br />✓ <br />RETENTION $Q <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOR/PARTNER/EXECUTIVE Y❑ <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />9286941 <br />10/28/2020 <br />10/28/2021 <br />�/ <br />PER <br />STATUTE <br />OERH <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />1$1.000.000 <br />E.L. DISEASE. POLICY LIMIT <br />$1,000,000 <br />A <br />A <br />Professional Liability <br />Contractors Pollution Liability <br />PPK2200038 <br />PPK2200038 <br />10/28/2020 <br />10/28/2020 <br />10/28/2021 <br />10/28/2021 <br />Per Claim: $1,000,000 <br />Aggregate: $2,000,000 <br />Per Claim: $1,000,000 <br />,Aggregate: $2000 000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />TE HOLDER CANCELLA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />*Evidence of Insurance* THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Michael Christian F <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />59351507 120-21 GL -UL -47C -PL -CPL I Sherry Young 112/29/2020 12:40:23 P61 (PST) Page 1 0£ 1 <br />
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