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COMPLIANCE INFO_2024
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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BENJAMIN HOLT
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2905
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2300 - Underground Storage Tank Program
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PR0231952
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
4/4/2025 3:16:24 PM
Creation date
1/12/2024 4:14:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0231952
PE
2351 - UST FACILITY - 2481 COMPLIANT
FACILITY_ID
FA0003712
FACILITY_NAME
CHEVRON STATION #94275*
STREET_NUMBER
2905
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
09760004
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\lsauers1
Supplemental fields
Site Address
2905 W BENJAMIN HOLT DR STOCKTON 95207
Tags
EHD - Public
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FrikizIRLan"RVAMINW �ftjIgHINIVtali 7n"n-R <br />DATE (MMIDOlYYYY) <br />12/27/2023 <br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFER5 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(les) 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 <br />Milestone Risk Management &Insurance Services <br />License No. 0672766 <br />8 Corporate Park, Suite 130 <br />Irvine <br />INSURED <br />Wayne Perry, Inc. <br />8281 Commonwealth Ave. <br />CA 92606 <br />I /PHMNE Fvl (949) 852-0909 I +ASC Net, (949) 852-1131 <br />cmontoya@mlleslonepromise.com <br />INsuRERA: Everest Indemnity Insurance <br />INsuFER B: Everest National Ins. Co. <br />Premier Insurance Co. <br />INsuRER D : Ohio Casualty Insurance Company <br />Buena Park CA 90621 (INSURERF: I <br />COVERAGES CERTIFICATE NUMBER: 23-24 Master REVISION NUMBER: <br />10120 <br />16045 <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 />INSLTR <br />TYPE OF INSURANCE <br />SD <br />WVD <br />POLICY NUMBER <br />POLIO <br />MMIDDIYYYY <br />EFF <br />POLICY EXP <br />MM/DIYYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,0001000 <br />CLAIMS -MAGE � OCCUR <br />DAM WE TO RENTED <br />PREMISES Ea occurrence <br />$ 60,000 <br />X <br />MED EXP (Any one person) <br />$ 51000 <br />Contr. Pollution Llab $1 M/$2M <br />A <br />X <br />Prof. Liab. Claims Made $1M/$2M <br />EF10E00006-231 <br />12/31/2023 <br />12/31/2024 <br />PERSONAL&ADV INJURY <br />$ 11000,000 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />GENERALAGGREGATE <br />$ 21000,000 <br />POLICY N PRO• ❑ LOC <br />JECT <br />PRODUCTS -COMP/OPAGG <br />$ 21000,000 <br />OTHER: XCU Silent <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 130001000 <br />BODILYINJURY(Perperson) <br />$ <br />ANYAUTO <br />BOWNED <br />SCHEDULED <br />AUTOS ONLY AUTOSHIRED <br />Ix <br />EF1CA00044231 <br />12/31/2023 <br />12/31/2024 <br />130DILYINJURY(Peraccident) <br />$ <br />PROPERTY DAMAGE <br />Peraccldenl <br />$ <br />NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />Comp $1000 X Coll $1000 <br />$ <br />UMBRELLA LIAB <br />1 X <br />OCCUR <br />EACHOCCURRENCE <br />$ 10,000,000 <br />X <br />AGGREGATE <br />$ 10,000,000 <br />A <br />EXCESS LIAR <br />CLAIMS•MADE <br />EF1X800007-231 <br />12/31/2023 <br />12/31/2024 <br />DEC) <br />RETENTION $ <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' AB <br />ANY PROPRIETOR/PARTNER/EXECUTiVE <br />OFFICER/MEMBER EXCLUDED? <br />(MandaR/MEM H) Y� <br />tory In <br />NIA <br />CA10003737231 <br />12/31/2023 <br />12/31/2024 <br />X <br />STATUTE <br />ERH <br />E L EACH <br />$ 11000,000 <br />EMPLOYEE <br />E.L.DISEASE CIEAEMPL <br />_ <br />$ 110005000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ 13000,000 <br />tallation Floaternted/Leased Equipment <br />t <br />BM02459216368 <br />12!31/2023 <br />12131/2024 <br />Installation Limit/Ded. <br />$250k/$2,500 <br />Rented/Leased Llmit/Ded <br />$150k/$2,500 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />rcfaTll:IreT� unf nf=R <br />CeNCFI i ATInN <br />©1988-2015 ACORD CORPORATION. All rights reserv <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" <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />AUTHORIZED REPRESENTATIVE <br />ed. <br />ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD <br />
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