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WP0043281
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4200/4300 - Liquid Waste/Water Well Permits
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WP0043281
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Entry Properties
Last modified
6/27/2022 12:44:24 PM
Creation date
6/27/2022 12:32:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0043281
PE
4372
STREET_NUMBER
1280
STREET_NAME
COTTAGE
STREET_TYPE
CT
City
MANTECA
Zip
95336-
APN
20826022
ENTERED_DATE
5/9/2022 12:00:00 AM
SITE_LOCATION
1280 COTTAGE CT
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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AC40RD CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYYY) <br />TYPE OF INSURANCE <br />04/27/2021 <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 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 <br />Mainline Insurance Services, Inc. <br />779 3rd Ave <br />Chula Vista CA 91910 <br />NCAO NTACT Janine Mendoza <br />PHONE (619) 420-8600 FAX (877) 467-6610 <br />EMAIL Janine@mainline ins.com <br />INSURERS AFFORDING COVERAGE NAIC # <br />EACH OCCURRENCE $ 1,000,000 <br />INSURER A: Evanston Insurance Company 35378 <br />MED EXP (Any oneperson) S 5,000 <br />INSURED <br />INSURER B <br />INSURER C: <br />California Geotech Services LLC <br />INSURER D <br />6886 Village Parkway <br />INSURER E: <br />Dublin CA 94568- <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 />INSR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY N MBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FX I OCCUR <br />X <br />3AA470560 <br />05/09/2021 <br />05/09/2022 <br />EACH OCCURRENCE $ 1,000,000 <br />AGE'Sr TO RENTED $ 100,000 <br />DAMr. <br />MED EXP (Any oneperson) S 5,000 <br />PERSONAL BADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO LOC <br />IPCT F-1AUTOMOBILE <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />$ <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON-OWNED <br />HIRED AUTOS AUTOS <br />COMBINED SINGLE LIMIT <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />-- <br />PROPERTY DAMAGE $ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />HCLAIMS-MADE <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED FFIRETENTION <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE F <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OF RATIONS below <br />NIA <br />WC STATU- OTH- <br />E.L. EACH ACCIDENT $ <br />E . DISEASE - EA EMPLOYEE $ <br />E.L. DISEASE -POLICY LIMIT 1 $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 401, Additional Remarks Schedule, if more space is required) <br />PROOF OF INSURANCE <br />CERTIFICATE HOLDER CANCELLATION A1000270 <br />Fax: ( ) - @ 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <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 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Fax: ( ) - @ 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />
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