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WP0037315
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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WP0037315
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Entry Properties
Last modified
10/1/2018 8:36:52 AM
Creation date
12/1/2017 4:12:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0037315
PE
4371
STREET_NUMBER
9422
Direction
E
STREET_NAME
SOUTH ORCHARD
STREET_TYPE
RD
City
ACAMPO
Zip
95220-
APN
01721030
ENTERED_DATE
9/14/2017 12:00:00 AM
SITE_LOCATION
9422 E SOUTH ORCHARD RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
DAfonskaia
Supplemental fields
FilePath
\MIGRATIONS\O\ORCHARD\9422\WP0037315.PDF
QuestysFileName
WP0037315
QuestysRecordID
3640261
QuestysRecordType
12
Tags
EHD - Public
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Client#: 318356 <br />FARWCORR <br />ACORD,., CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY)7/21/2015 <br />TYPE OF INSURANCE <br />ADDL <br />INSR <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />NAME: Irene McCleary <br />HUB Int'I Insurance Serv. Inc.PHONE <br />877-825-2681 FAX 951-231-2572 <br />AIC No Ext): A/C No <br />License #0757776 <br />AE -MAIL Cal.CPU@hubinternational.com <br />4371 Latham Street #101 <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />INSURER(S) AFFORDING COVERAGE NAIC# <br />Riverside, CA 92501 <br />INSURER A: Liberty Mutual Fire Insurance C 23035 <br />INSURER B : <br />INSURED <br />FARWEST CORROSION CONTROL COMPANY <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />INSURER C: <br />12029 Regentview Avenue <br />Downey, CA 90241-5517 <br />INSURER D <br />BODILY INJURY (Per person) $ <br />INSURER E <br />PROPERTY DAMAGE $ <br />Per accident <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 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 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 7 OCCUR <br />EACH OECCCUR��RENCE $ <br />PREMISES EaEoNccurrDence $ <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO JECT LOC <br />PRODUCTS - COMP/OP AGG $ <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />COMBINED SINGLE LIMIT <br />Ea accident <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />PROPERTY DAMAGE $ <br />Per accident <br />$ <br />UMBRELLA UAB <br />EXCESS LIAB <br />HOCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED I I RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATIONWC2Z61036697195 <br />AND EMPLOYERS' UABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N <br />OFFICER/MEMBER EXCLUDED? y <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N I A <br />8/04/2015 <br />08/04/201 <br />X WC STATU- OTH- <br />E.L. EACH ACCIDENT $1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $1,000,000 <br />E.L. DISEASE- POLICY LIMIT $1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Verification of Insurance. <br />*Verification of Insurance* <br />ACORD 25 (2010/05) 1 of 1 <br />#S3619084/M3619072 <br />laatq_\111LNJCI <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 />AUTHORIZED REPRESENTATIVE <br />'J 1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />TP42 <br />
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