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WP0042091
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ZUCKERMAN
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042091
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Entry Properties
Last modified
8/5/2021 3:59:59 PM
Creation date
8/5/2021 3:10:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042091
PE
4371
STREET_NUMBER
2121
Direction
N
STREET_NAME
ZUCKERMAN
STREET_TYPE
RD
City
STOCKTON
Zip
95206-
APN
12908009
ENTERED_DATE
5/27/2021 12:00:00 AM
SITE_LOCATION
2121 N ZUCKERMAN RD
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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DATE(MMIDD/YYYY) <br /> .44COIR o CERTIFICATE OF LIABILITY INSURANCE 7/1/2021 6/23/2020 <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 policy(les)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 Lockton Companies CONTACT - <br /> Three City Place Drive,Suite 900 PHONE FAX <br /> No): <br /> St.Louis MO 63141-7081 E-MAIL <br /> (314)432-0500 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC A <br /> INSURER A:XL Insurance America Inc. 24554 <br /> INSURED Corrpro Companies,Inc. INSURER B:ACE American Insurance Company 22667 <br /> 1316495 p p <br /> 20991 Cabot Boulevard,Building 5 INSURER C:Indemnity Insurance Co of North America 43575 � <br /> Hayward CA 94545 INSURER D:Starr Indemnity&Liability Company— 38318 <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CORC002 CERTIFICATE NUMBER: 15495702 REVISION NUMBER: XXXXXXX <br /> THIS IS TO CERTIFY TI IAT 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, j <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1 <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDPOLICY EFFPOLICY <br /> MM DDY EXP <br /> LTR VVVD LIMITS I1 <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2 00O 000 <br /> DAMAGE A X Y Y CGD300084905 7/1/2020 7!11202] CTO RE <br /> _—_,_ <br /> A CLAIMS-MADE OCCUR XCLJ/BROAD FORM PD PREMISES(Ea occurrence) $.11000 000 <br /> i <br /> MED EXP(Any one person) $ 10,000_ <br /> PERSONAL d ADV INJURY $ 2,000,000 <br /> ` <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4 000 000 <br /> POLICY PECOT- D 1 LOC PRODUCTS-COMPIOP AGG $ 4:000:000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY Y y ISAH25302540 7/1/2020 7/1/2021 Ea accidentSINGLE IMIT $ 5 000 000 <br /> X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX <br /> AUTOS ONLY AUTOS $ XXXXXXX <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> SXXXXXXX <br /> D UMBRELLA LIAB OCCUR Y Y 1000095154201 7/1/2020 7/1/2021 EACH OCCURRENCE $ 5,000,000 <br /> i X EXCESS UAB CLAIMS-MADE AGGREGATE s 5,000,000 <br /> DED RETENTION$ S XXXXXXX <br /> WORKERS COMPENSATION Y WLRC67457262 CA/MA 7/1/2020 7/1/2021 X STATUTE ERH <br /> H AND EMPLOYERS'LIABILITY ) <br /> ANY PROPRIETORIPARTNER/EXECUTIVE YIN WLRC67457225(AGS) 7/1/2020 7/1/2021 E.L.EACH ACCIDENT S 1 000000 <br /> C OFFICER/MEMBER EXCLUDED? FN] NIA (EXCLUDING MONOPOLISTIC <br /> (Mandatory in NH) E.L,DISEASE-EA EMPLOYEE S 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) <br /> PROJECT:INSTALLATION OF CATHODIC PROTECTION. <br /> 1 <br /> !i <br /> CERTIFICATE HOLDER CANCELLATION See Attachments <br /> 15495702 <br /> UNDERGROUND CONSTRUCTION CO.,INC. <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 5145 INDUSTRIAL WAY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> BENICIA CA 94510 <br /> AUTHORIZED REPRESENTATI <br /> I <br /> i <br /> ! ©1988-2 CORD CORPORAT N. All rights reserved. <br /> i ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br /> pf <br /> C <br /> t <br />
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