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COMPLIANCE INFO_2022
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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PR0231458
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
10/17/2023 4:14:49 PM
Creation date
2/2/2022 11:07:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0231458
PE
2361
FACILITY_ID
FA0001196
FACILITY_NAME
SAVE ON FUEL
STREET_NUMBER
420
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95337
APN
219-312-06
CURRENT_STATUS
01
SITE_LOCATION
420 W YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\kblackwell
Tags
EHD - Public
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 60 B <br /> ( Ed . 1 -15 ) <br /> EMPLOYERS ' LIABILITY COVERAGE AMENDATORY ENDORSEMENT-CALIFORNIA <br /> The insurance afforded by Part Two ( Employers ' Liability Insurance ) by reason of designation of California in item 3 of the <br /> information page is subject to the following provisions : <br /> A . " How This Insurance Applies , " is amended to read as follows : <br /> A. How This Insurance Applies <br /> This employers ' liability insurance applies to bodily injury by accident or bodily injury by disease . Bodily injury means a <br /> physical injury , including resulting death . <br /> 1 . The bodily injury must arise out of and in the course of the injured employee 's employment by you . <br /> 2 . The employment must be necessary or incidental to your work in California . <br /> 3 . Bodily injury by accident must occur during the policy period . <br /> 4 . Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day <br /> of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy <br /> period . <br /> 5 . If you are sued , the original suit and any related legal actions for damages for bodily injury by accident or by disease <br /> must be brought in the United States of America , its territories or possessions , or Canada . <br /> E . The " Exclusions " section is modified as follows (all other exclusions in the " Exclusions" section remain as is) : <br /> 1 . Exclusion 1 is amended to read as follows : <br /> 1 , liability assumed under a contract. <br /> 2 . Exclusion 2 is deleted . <br /> 3 . Exclusion 7 is amended to read as follows : <br /> 7 . damages arising out of coercion , criticism , demotion , evaluation , reassignment, discipline , defamation , harassment, <br /> humiliation , discrimination against or termination of any employee , termination of employment, or any personnel <br /> practices , policies , acts or omissions . <br /> 4 . The following exclusions are added : <br /> 1 . bodily injury to any member of the flying crew of any aircraft. <br /> 2 . bodily injury to an employee when you are deprived of statutory or common law defenses or are subject to penalty <br /> because of your failure to secure your obligations under the workers' compensation law(s) applicable to you or <br /> otherwise fail to comply with that law. <br /> 3 , liability arising from California Labor Code Section 2810 . 3 which relates to labor contracting . <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated . <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy . ) <br /> Endorsement Effective 12/11 /2021 Policy No . WWC3560056 Endorsement No , 0 <br /> Insured Tank-Tight Systems Inc <br /> Insurance Company Wesco Insurance Company <br /> Countersigned by <br /> WC 04 03 60 B <br /> ( Ed . 1 - 1 5) <br /> © Copyright 2015 by the Workers' Compensation Insurance Rating Bureau of California . All rights reserved . From <br /> the WCIRB 's California Workers' Comensation Insurance Forms Manual © 2001 . <br />
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