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COMPLIANCE INFO_2022
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HAMMER
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2300 - Underground Storage Tank Program
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PR0518624
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
11/30/2022 8:16:02 AM
Creation date
3/3/2022 10:24:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0518624
PE
2371
FACILITY_ID
FA0024496
FACILITY_NAME
Costco Wholesale #38 (Gas Station)
STREET_NUMBER
1630
Direction
E
STREET_NAME
HAMMER
STREET_TYPE
Ln
City
Stockton
Zip
95210
APN
09428011
CURRENT_STATUS
01
SITE_LOCATION
1630 E Hammer Ln
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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A ' DATE (MMIDDIYYYY) <br /> ,.. CERTIFICATE OF LIABILITY INSURANCE 12/17/2021 <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), 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 CONTACT <br /> AME CT Catherine Montoya <br /> Milestone Risk Management & Insurance Services PHONE (949) 852.0909 FAX ' (949) 852-1131 <br /> AIC Na Ext): A1C, No <br /> License No, OB72766 ADDRESS: cmontoya@milestoneprom(se.com <br /> 8 Corporate Park , Suite 130 INSURER(S) AFFORDING COVERAGE NAIC # <br /> Irvine CA 92606 INSURERA : Everest Indemnity Insurance 10851 <br /> INSURED INSURER B : Everest Premier Insurance Co. 16045 <br /> Wayne Perry, Inc. INSURER C : <br /> 8281 Commonwealth Ave. INSURER 0 : <br /> INSURER E <br /> Buena Park CA 90621 INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: 21 -22 City REVISION NUMBER: <br /> THIS IS TO CERTIFYTHAT 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 MAYBE 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 ADDL SUBRIPOLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE gD WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 ,000,000 <br /> DAMAGE TO <br /> C- L-A._t.M._S.__MA. . D. -E- —X ..00CUR C <br /> 30,000 <br /> _._.__. . ._ FMEaamir3nco . <br /> MED EXP Any one person $ 25,000 <br /> A EFIML00079211 12/31/2021 12/31 /2022 PERSONAL & ADV INJURY $ 11000 ,000 <br /> GEN'LAGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE $ 21000 ,000 <br /> POLICY ❑ jEGT F�] LOC PRODUCTS • COMP/OP AGO $ 21000 ,000 <br /> OTHER; Employee Benefits $ 1100000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 ,000,000 <br /> Ea accident) <br /> X ANY AUTO BODILY INJURY (Per person) 3 <br /> A OWNED SCHEDULED EF1CA00044211 12/31 /2021 12/31 /2022 BODILY INJURY (Per aeddent) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY cclde t $ <br /> UMBRELLA LIAR X1 OCCUR EACH OCCURRENCE $� 10,000,000 <br /> A ^ EXCESS LIAS CLAIMS-MADE EFlC000052211 12/31 /2021 12/31 /2022 AGGREGATE _ $ 10,000,000 <br /> DED RETENTION $ $ <br /> WORKERS COMPENSATIONvv PER OTH- <br /> AND EMPLOYERS' LIABILITY ^ STATUTE R <br /> ANY PROPRIETOR/PARTNERIEXECUTIVE F�vYIN E,L. EACH ACCIDENT $ 10000, 000 <br /> B OFFICERIMEMBEREXCLUDED? NIA CA10003737221 12/31 /2021 12/31 /2022 <br /> (Mandatory In NH) E.L. DISEASE - FA EMPLOYEE $ 11000, 000 <br /> It yes, describe under <br /> DESCRIPTION OF OPERATIONS below E.L, DISEASE • POLICY LIMIT $ 1 ,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Addltlonal Remarks Schedule, may be attached It more apace Is required) <br /> * Evidence of Coverage* <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN <br /> *Evidence of Coverage* ACCORDANCE WITH THE POLICY PROVISIONS, <br /> AUTHORIZED REPRESENTATIVE <br /> © 1988-2015 ACORD CORPORATION. All rights reserved . <br /> ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD <br />
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