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COMPLIANCE INFO_2024
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KETTLEMAN
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2300 - Underground Storage Tank Program
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PR0231348
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
3/4/2025 11:36:02 AM
Creation date
1/31/2024 8:51:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0231348
PE
2361 - UST FACILITY
FACILITY_ID
FA0003803
FACILITY_NAME
KETTLEMAN CHEVRON
STREET_NUMBER
601
Direction
E
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04728006
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\lsauers1
Supplemental fields
Site Address
601 E KETTLEMAN LN LODI 95240
Tags
EHD - Public
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ACORV CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br /> lliww /" 1 10/25/2023 <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 been rsed . <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 /> Inszone Insurance Services , LLC PHONE Certificate Team FAX <br /> 2721 Citrus Road , Suite AWC, No Ext : 877-308-9663 Alc No) : 916400-2625 <br /> Rancho Cordova , CA 95742 aDORess: certs inszoneins . com <br /> INSURER(S) AFFORDING COVERAGE NAIC # <br /> License#: OF82764 INSURER A : Starstone Specialty Insurance Co . 44776 <br /> INSURED BZSERVI-01 INSURER B : Infinity Select Insurance Company 20260 <br /> BZ Service Station Maintenance , Inc. <br /> P . O . Box 933 INSURER C : Security National Insurance Company 19879 <br /> West Sacramento , CA 95691 INSURER D : <br /> INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: 287855953 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS <br /> LTR <br /> A X COMMERCIAL GENERAL LIABILITY L86445231AEM 2/15/2023 2/15/2024 EACH OCCURRENCE $ 1 , 000 , 000 <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED <br /> PREMISES Ea occurrence $ 100 , 000 <br /> MED EXP (Any one person) $ 10, 000 <br /> PERSONAL & ADV INJURY $ 1 , 000 , 000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2, 000 , 000 <br /> X POLICY ❑ PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2, 000 , 000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY 504610143114001 8/19/2023 8/19/2024 COMBINED SINGLE LIMIT $ 1 , 000 , 000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY (Per person) $ <br /> OWNED SCHEDULED BODILY INJURY (Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTYDAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> L $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION $ $ <br /> C WORKERS COMPENSATION SNP1464367 10/27/2023 10/27/2024 X STATUTE EOTH <br /> AND EMPLOYERS' LIABILITY Y I N <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ 1 , 000, 000 <br /> OFFICER/MEMBER EXCLUDED? N / A <br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1 , 000, 000 <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below I I E.L. DISEASE - POLICY LIMIT $ 1 , 000, 000 <br /> A Professional Liability L86445231AEM 2/15/2023 2/15/2024 Aggregate/Occurance 2000000/1000000 <br /> A Pollution Liability L86445231AEM 2/15/2023 2/15/2024 Aggregate/Occurance 200000011000000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) <br /> CSLB # 433159 <br /> Verification Of Insurance <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 /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Contractors State License Board <br /> P . O . Box 26000 <br /> AUTHORIZED REPRESENTATIVE - <br /> Sacramento , CA 95826 — , <br /> © 1988-2015 ACORD CORPORATION . All rights reserved . <br /> ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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