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COMPLIANCE INFO_2022
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2300 - Underground Storage Tank Program
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PR0527629
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
7/1/2022 10:58:11 AM
Creation date
3/3/2022 10:27:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0527629
PE
2351
FACILITY_ID
FA0018721
FACILITY_NAME
Costco Wholesale #1031
STREET_NUMBER
2440
STREET_NAME
DANIELS
STREET_TYPE
ST
City
MANTECA
Zip
95337
CURRENT_STATUS
01
SITE_LOCATION
2440 DANIELS ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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® CONTRACTORS STATE LICENSE BOARD STATE OF CALIFORNIA <br /> 9821 Business Park Drive, Sacramento, California 95827 Governor Gavin Newsom <br /> Mailing Address : P . O . Box 26000 , Sacramento, CA 95826 <br /> woo <br /> 800. 321 . CSLB (2752) i www. cslb. ca. gov I CheckTheLicenseFirst. com <br /> Date Created <br /> Workers ' Compensation Insurance 03/31 /2021 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER , THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND , EXTEND OR ALTER THE COVERAGE <br /> AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE <br /> ISSUING INSURER(S) , AUTHORIZED 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 <br /> endorsed . If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A <br /> statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). , <br /> PRODUCER AGENT/BROKER NUMBER: OB29370 <br /> Edgewood Partners Insurance Centers (EPIC ) CONTACT <br /> 3000 Executive Pkwy NAME: Certificates Department <br /> Ste 325 PHONE Fax <br /> San Ramon , CA 94583 (A/C. No. Ext): 9252447700 (A/C. No): <br /> E-MAIL: EPICcerts@epicbrokers. com <br /> INSURER AFFORDING COVERAGE; NAIC # <br /> INSURED INSURER A: ZURICH AMERICAN INSURANCE COMPANY 16535 <br /> GETTLER RYAN INC <br /> 6805 SIERRA CT STE G <br /> DUBLIN , CA 94568 <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 <br /> PERIOD INDICATED , NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT <br /> TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT <br /> TO ALL THE TERMS , EXCLUSIONS AND CONDITIONS OF SUCH POLICIES , LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE <br /> CLAIMS-MADE OCCUR <br /> DAMAGE TO RENTED <br /> PREMISES (Ea occurrence) <br /> MED EXP (Any one person) <br /> PERSONAL & ADV INJURY <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE <br /> PRO- <br /> POLICY F] JECT Q LOC PRODUCTS - -COMP/OP AGG <br /> OTHER <br /> A WORKERS COMPENSATION N / A WC090463402 04/01 %2021 04/01 /2022 <br /> AND EMPLOYERS' LIABILITY �T <br /> Contractors license number or application fee number of insured : License Number: 220793 <br /> Comments <br /> CERTIFICATE HOLDER CANCELLATION <br /> Contractors State License Board SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> P . O . BOX 26000 ACCORDANCE WITH THE POLICY PROVISIONS , <br /> Sacramento , CA 95826 AUTHORIZED REPRESENTATIVE .cam <br /> Certificates Department <br /> IIIIIIIIIIIIIIIIIIIIIIIIIIIIVIII' IIII ' IIIIII ( I 'I 'I) IITIIIIIIIIIIIIIIIVIIIIIIIIII ' IIIIIII) IIIIIIIII (IIIIII IIII ' IIII� IIIIIIIIIIII'lllllll'll <br /> WC - CERT 220793 03 / 31 / 2021 <br /> V1 .0 <br />
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