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COMPLIANCE INFO_2025
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PR0232587
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COMPLIANCE INFO_2025
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Entry Properties
Last modified
4/28/2026 8:28:46 PM
Creation date
1/14/2025 10:34:21 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2025
RECORD_ID
PR0232587
PE
2361 - UST FACILITY
FACILITY_ID
FA0004521
FACILITY_NAME
CHEVRON USA #201761*
STREET_NUMBER
1103
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95337
APN
21935038
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
Site Address
1103 S MAIN ST MANTECA 95337
Tags
EHD - Public
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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYW) <br /> A��0® <br /> 12/27/2023 <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 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 CONTACT Catherine Montoya <br /> NAME: <br /> Milestone Risk Management& Insurance Services AI� No Ext : (949) 852-0909 nlc,No): (949) 852-1131 <br /> License No. OB72766 E-MAIL cmontoya@milestonepromise.com <br /> ADDRESS: <br /> 8 Corporate Park, Suite 130 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Irvine CA 92606 INSURERA: Everest Indemnity Insurance 10851 <br /> INSURED INSURER B : Everest National Ins. Co. 10120 <br /> Wayne Perry, Inc. INSURER C : Everest Premier Insurance Co. 16045 <br /> 8281 Commonwealth Ave. INSURER D : Ohio Casualty Insurance Company 24074 <br /> INSURER E: <br /> Buena Park CA 90621 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 23-24 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 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 AUUL15Ut5K POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDIYYYY MMIDD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE � OCCUR D ET E 50,000 <br /> PREMISES Ea occurrence $ <br /> X Contr. Pollution Liab $1 M/$2M MED EXP(Any one person) $ 5,000 <br /> A X Prof. Liab. Claims Made $1M/$2M EFlCE00006-231 12/31/2023 12/31/2024 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 <br /> JECT ❑ LOC PRODUCTS-COMP/OPAGG $POLICY PRO 2,000,000 <br /> X OTHER: XCU Silent $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> JX ANYAUTO BODILY INJURY(Per person) $ <br /> BOWNED SCHEDULED EFlCA00044231 12/31/2023 12/31/2024 BODILYINJURY(Peraccident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident Comp $1000 Ix Coll $1000 $ <br /> UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 <br /> A X EXCESS LIAB CLAIMS-MADE EFlXS00007-231 12/31/2023 12/31/2024 AGGREGATE $ 10,000,000 <br /> DED I I RETENTION $ $ <br /> WORKERS COMPENSATION X STER ATUTE ORH <br /> AND EMPLOYERS'LIABILITY YIN — <br /> ANYPROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 <br /> C OFFICER/MEMBER EXCLUDED? NIA CA10003737231 12/31/2023 12/31/2024 —.-- <br /> (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ <br /> Installation Floater <br /> D Rented/Leased Equipment BM02459216368 12/31/2023 12/31/2024 Installation Limit/Ded. $250k/$2,500 <br /> Rented/Leased Limit/Ded I $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 /> 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 /> *Evidence of Coverage* ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> © 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />
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