My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
WP0037794
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
V
>
VAL DERVIN
>
123
>
4200/4300 - Liquid Waste/Water Well Permits
>
WP0037794
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/24/2018 11:53:44 AM
Creation date
8/23/2018 1:16:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0037794
PE
4372
STREET_NUMBER
123
STREET_NAME
VAL DERVIN
STREET_TYPE
PKWY
City
STOCKTON
Zip
95206
APN
19337002
ENTERED_DATE
1/11/2018 12:00:00 AM
SITE_LOCATION
123 VAL DERVIN PKWY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
AMeuangkhoth
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
8
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
SALEENG-01 <br />MMAZZA <br />.d#% O CERTIFICATE OF LIABILITY INSURANCE <br />�� <br />DATE 12/01/2017Y) <br />12/01 /2017 <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 License # OE02096 <br />COME CT <br />PH/ IN o, Ext): (559) 432-0222 jA/Ac , No):(559) 431-7941 <br />DiBuduo & DeFendis Insurance Brokers, LLC <br />P.O. Box 5479 <br />Fresno, CA 93755-5479 <br />AeD IL <br />U <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A:Valley Forgle Insurance Co 20508 <br />12/01/2017 <br />INSURED <br />INSURERB:Continental Insurance Company 35289 <br />INSURERC:American Casualty Company of Reading PA 20427 <br />Salem Engineering Group, Inc. <br />INSURER D: Continental Casual Company 20443 <br />4729 W. Jacquelyn Ave. <br />Fresno, CA 93722 <br />INSURER E <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 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 <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXPLTR <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />X <br />6015893246 <br />12/01/2017 <br />12/01/2018 <br />EACH OCCURRENCE $ 2,000,000 <br />DAMAGE TO RISES (E.ENTED $ 300,000 <br />MED EXP (Any oneperson) $ 15,000 <br />PERSONAL&ADV INJURY $ 2,000'000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY F_x1 JELQT 7 LOC <br />GENERAL AGGREGATE $ 4,000,000 <br />PRODUCTS -COMP/OPAGG $ 4,000,000 <br />$ <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />C e BCB.INED ldent)SINGLE LIMIT $ 1,000,000 <br />BODILY INJURY Perperson) $ <br />X <br />ANY AUTO <br />6045473729 <br />12/01/2017 <br />12/01/2018 <br />OWNED SCHEDULED <br />AUTOS ONLY AUUTJOSWNEp <br />BODILY INJURY Per accident $ <br />PPeoacEciident AMAGE $ <br />AUTOS ONLY AUTO ONLY <br />B <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE $ 5'000'000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />6015893232 <br />12101/2017 <br />12/01/2018 <br />AGGREGATE $ 5'000'000 <br />DED I X I RETENTION $ 10,000 <br />S <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />N / A <br />6020581635 <br />12/01/2017 <br />12/01/2018 <br />X PEROTH- <br />ST ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ 1'000'000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />D <br />Prof./Pollution Liab <br />AEH591895527 <br />12/01/2017 <br />12/01/2018 <br />Each Claim 2,000,000 <br />D <br />Prof./Pollution Liab <br />AEH591895527 <br />12/01/2017 <br />12/01/2018 <br />Aggregate 4,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Certificate Holder is named Additional Insured (including Completed Operations and Primary Non -Contributory Wording) as respects General Liability per <br />attached blanket policy form CNA75079XX (1-15). <br />Professional/Pollution Liability deductible per claim - $35,000 <br />Actual Certificate to be issued upon request <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />** SAMPLE CERTIFICATE ** <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />I <br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />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.