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COMPLIANCE INFO_2024
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2300 - Underground Storage Tank Program
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PR0231072
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
2/4/2025 9:03:45 AM
Creation date
5/7/2024 4:11:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0231072
PE
2361 - UST FACILITY
FACILITY_ID
FA0002048
FACILITY_NAME
TESORO ā(SPEEDWAY)ā 68221
STREET_NUMBER
2705
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12121008
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\lsauers1
Supplemental fields
Site Address
2705 COUNTRY CLUB BLVD STOCKTON 95204
Tags
EHD - Public
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L R CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) <br /> 03/03/2023 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE III 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 /> PRODUCERCONE <br /> NTACT Shale Pearson <br /> : <br /> TLB Insurance Services AlCNN <br /> Exit! (916) 7905863 (AIc No : (686) 329-8842 <br /> CA License #OB62095 EMAIL 5: shala-pearson@leavitt.com <br /> ADDRE <br /> 2356 Maritime Dr, Ste 100 <br /> INSURER(S) AFFORDING COVERAGE NAIC q <br /> Elk Grove CA 95758 INSURER A : Westchester Surplus Lines Insurance Company 10172 <br /> INSURED INSURER B ; Travelers Property Casualty Company of America 25674 <br /> Walton Engineering , Inc. INSURER C : Service American Indemnity Company 39152 <br /> P. O, Box 1025INSURER D : Travelers Property Casualty Company. 36161 <br /> INSURER E : <br /> West Sacramento CA 95691 INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: 23124 Master 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 CONTRACTOR 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 /> /LTR TYPE OF INSURANCE MSO yyvD POLICY NUMBER <br /> MMIDDIYYYYOLICY EFI MMIDDIYYYYI LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 <br /> t5AMAV2E TO RENTED <br /> CLAIMS-MADE F OCCUR PREMISES Eaaccurrence $ 50,000 <br /> X Inc. Pollution Liability MED EXP (Any one person) $ 5 , 000 <br /> A X Inc. Professional Liability G47393735001 03/06/2023 03/06/2024 PERSONAL BAOV INJURY $ 11000 , 000 <br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 21000,000 <br /> POLICY ] PRO- Iā) <br /> JECT El LOC PRODUCTS - COMPIOPAGG S 2, 000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 , 000 ,000 <br /> Ea accidanl <br /> X ANY AUTO BODILY INJURY (Per person) $ <br /> B OWNED SCHEDULED 810BL785302 03/06/2023 03/06/2024 BODILY INJURY (Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED <br /> X AUTOSONLY X AUTOS ONLY PROPERTY DAMAGE $ <br /> Per accident - <br /> Uninsured motorist $ 1 , 000, 000 <br /> UMBRELLA LIAR ....014,,00 ,.,.. ,0000,. ,.. . .., <br /> OCCUR EACH OCCURRENCE $ %0001000 <br /> X EXCESS LIAR CLAIMS-MADE G47393747001 03/06/2023 03/06/2024 AGGREGATE $ 1010000000 <br /> DED X RETENTION $ 0 <br /> LA $ <br /> WORKERS COMPENSATION _ <br /> AND EMPLOYERS' LIABILITY YIN X STATUTE ERH <br /> C ANY PROPRIETORIPARTNEWEXECUTIVE ā NIA SAMTWC10020101 10/01 /2023 10!01 /2024 EL EACH ACCIDENT $ 1 , 000, 000 <br /> OFFICEWMEMBER EXCLUDED? <br /> (Mandatory In <br /> If yes, describe under <br /> er E. L DISEASE - EA EMPLOYEE $ <br /> 1 ,000, 000 <br /> DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ 1 , 0001000 <br /> Inland Marine <br /> D Leased/Rented/Borrowed 6608K816207 03/06/2023 03/06/2024 Limit $ 300, 000 <br /> Deductible $2, 500 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached if more space is required) <br /> CERTIFICATE HOLDER <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> To Whom it May Concern Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS, <br /> AUTHORIZED REPRESENTATIVE <br /> © 19884015 ACORD CORPORATION . All rights reserved. <br /> ACORD 26 (2016/03 ) The ACORD name and logo are registered marks of ACORD <br />
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