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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0529124
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
12/29/2021 10:46:49 AM
Creation date
10/5/2021 9:29:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0529124
PE
2351
FACILITY_ID
FA0019437
FACILITY_NAME
ARCO am/pm # 83230
STREET_NUMBER
1340
Direction
W
STREET_NAME
COLONY
STREET_TYPE
Rd
City
Ripon
Zip
95366
APN
261-590-110-000
CURRENT_STATUS
01
SITE_LOCATION
1340 W Colony Rd
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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��•�.� DIAMO=4 OP ID: AS <br /> CERTIFICATE OF LIABILITY INSURANCE DATEcMM/DD"YYY' <br /> 09/24/2021 <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)1 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 CONTACT P.J. Chawla <br /> NAME: <br /> Peck & Peck Insurance Brokers PHONE Extio 650.592.5591 ac Nob 650492-0404 <br /> 1724 Laurel Street Suite 225 <br /> San Carlos, CA 94070 anDaegs, MYBROKER US&COM <br /> P.J. Chawla <br /> INSURER($) AFFORDING COVERAGE NAtC S <br /> INSURER A : Mese Underwriters Specialty <br /> INSURED Diamond Petroleum Services Inc INSURER B : state Compensation Ina Fund 35076 <br /> Guadalupe Sanchez <br /> 3619 King Rd INSURER C <br /> Antioch, CA 94509 INSURER 0 : <br /> INSURER E <br /> INSURER F <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 /> !NSR TYPE OF INSURANCE POLICY NUMBER MMMD EFF MMtIDA EXP <br /> LTR LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 110001000 <br /> CLAIMSwMADE a OCCUR MP0002008001028 09/0912021 0910912022 DAMAGE TO RFNTEU <br /> PREMISES Ea occurrence S 100,00 <br /> MED EXP (Any one person) 5900 <br /> PERSONAL & ADV INJURY E 11000100 <br /> GEITL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 21000100 <br /> X POLICY [:] JEST F LOC PRODUCTS - COMP/OPAGG S Z,000IOO <br /> OTHER: E <br /> EaaoddSINGLE IMR <br /> AUTOMOBILE LIABILITY accident) <br /> E <br /> ANYAUTO BODILY INJURY (Per person) $ - <br /> ALLOSNED SACOEDULED BODILY INJURY (Per accident) E <br /> NON OWNED PROPERTY DAMAGE E <br /> HIRED AUTOS AUTOS Per accident <br /> l E <br /> UMBRELIA LIAB OCCUR EACH OCCURRENCE E <br /> EXCESS LIAB CLAIMSwMADE AGGREGATE E <br /> DED RETENTIONS E <br /> WORKERS COMPENSATION X I STATUTEI ER <br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE Yl07/21 /2021 07!2112022 El N / A 9214798-21 El EACH C <br /> ACCIDENT E 1 ,000100E <br /> AND EMPLOYERS' LIABILITY <br /> DISEAS <br /> OFFICER/MEMBEREXCLUDED7 EAEMPLO E - ^ 1 /000100 <br /> (Mandatory In NH) <br /> Ues, eunder E,L. DISEASE - POLICY LIMIT S 11000,00 <br /> DESCRIPTIOIPTION OF OPERATIONS below <br /> A Property Coverage MP0002008001026 09/0912021 09/09/2022 10100 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached If more apace Is required) <br /> Proof of Insurance Only, <br /> CERTIFICATE HOLDER CANCELLATION <br /> BLANK4 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ***Proof of Insurance*" ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> © 1988.2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 26 (2014101 ) The ACORD name and logo are registered marks of ACORD <br />
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