My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2025
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
H
>
HARNEY
>
255
>
2300 - Underground Storage Tank Program
>
PR0537549
>
COMPLIANCE INFO_2025
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/24/2026 2:05:03 PM
Creation date
4/2/2025 10:59:29 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2025
RECORD_ID
PR0537549
PE
2351 - UST FACILITY - 2481 COMPLIANT
FACILITY_ID
FA0021617
FACILITY_NAME
HARNEY LANE AM PM
STREET_NUMBER
255
Direction
E
STREET_NAME
HARNEY
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06258040
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
Site Address
255 E HARNEY LN LODI 95240
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
46
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
DATE(MMIDD/YYYY) <br /> A�" CERTIFICATE OF LIABILITY INSURANCE 2/25/2025 <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 <br /> NAME: Certificate Team <br /> Inszone Insurance Services, LLC PHONE FAX <br /> 2721 Citrus Road, Suite A c o E • 877-308-9663 A/C, <br /> /c No): 916-400-2625 <br /> Rancho Cordova, CA 95742 aDORess: certs@inszoneins.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> License#: OF82764 INSURER A: Westchester Surplus Lines Co. 10172 <br /> INSURED BZSERVI-01 INSURERB : Infinity Select Insurance Company 20260 <br /> BZ Service Station Maintenance, Inc. <br /> P.O. Box 933 INSURER c : Omaha National Casualty Company 32107 <br /> West Sacramento, CA 95691 INSURERD: <br /> INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: 2043447343 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 ADDLSUBRTYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP <br /> LTR MMIDD/YYW MMIDDIYYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY G4896722A 001 2/15/2025 2/15/2026 EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 100,000 <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL 8 ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 <br /> POLICY PROJECT ❑ LOC PRODUCTS-COMP/OP AGG $2,000.000 <br /> X <br /> OTHER: <br /> B AUTOMOBILE LIABILITY 50013611401 8/19/2024 8/19/2025 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 PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> C WORKERS COMPENSATION ONCC17012248-01 10/27/2024 10/27/2025 X STATUTE EORH <br /> AND EMPLOYERS'LIABILITY Y/N <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ 1,000,000 <br /> A Professional Liability G4896722A 001 2/15/2025 2/15/2026 Aggregate $2,000,000 <br /> A Professional Liability G4896722A 001 2/15/2025 2/15/2026 Each Claim $1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Pollution Liability - Policy Number: G4896722A 001 - Policy Effective Date: 2/15/2025 - Policy Expiration Date: 2/15/2026 - Aggregate: $2,000,000 - <br /> Occurrence: $1,000,000 - Insurer A: Westchester Surplus Lines Insurance Co. - NAIC #10172 <br /> Equipment Floater- Policy Number: 57MSBA0829 - Policy Effective Date: 2/15/2025 - Policy Expiration Date: 2/15/2026 - Leased Rented Equipment: <br /> $100,000 - Deductible: $5,000 - Insurer D: Hartford Fire Insurance Company - NAIC #19682 <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 /> Verification Of Insurance AUTHORIZED REPRESENTATIVE <br /> © 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
The URL can be used to link to this page
Your browser does not support the video tag.