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COMPLIANCE INFO_2016-2018
Environmental Health - Public
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EHD Program Facility Records by Street Name
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HAMMER
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2300 - Underground Storage Tank Program
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PR0518624
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COMPLIANCE INFO_2016-2018
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Last modified
3/11/2021 11:13:49 AM
Creation date
11/5/2018 11:20:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2016-2018
RECORD_ID
PR0518624
PE
2371
FACILITY_ID
FA0024496
FACILITY_NAME
Costco Wholesale #38 (Gas Station)
STREET_NUMBER
1630
Direction
E
STREET_NAME
HAMMER
STREET_TYPE
Ln
City
Stockton
Zip
95210
APN
09428011
CURRENT_STATUS
01
SITE_LOCATION
1630 E Hammer Ln
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\H\HAMMER\1630\PR0518624\COMPLIANCE INFO 2016-PRESENT .PDF
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EHD - Public
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�1 JONECOV-02 DADACAYA <br /> AG ORO' <br /> DATE(MM/DD/YYYY) <br /> CER <br /> JVICATE OF LIABILITY INSUONCE 6/24/2016 <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: N the certificats holder is an ADDITIONAL INSURED,the policy(les)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 LICBDEe 9 9E67763NT <br /> IDA Insurance Services NAME: <br /> 130 Vantis -„_, ,® � ar - HONE 8 297-0982 ^'I <br /> Sults 250 No• 948 297-5960 <br /> Aliso Viejo,CA 92656 �"'� y,®, AIMDIaeLees: <br /> MSUR AM"CM INS COVEWn <br /> NeuRUA:Colon Inslxance CoINSURED INBURM s:Philadel his InAo= lnsJones Covey Group,Ina muRaa c:Evetfat National Insurance <br /> Ranch9595 o Cu Rencamonga A 91tWV�RONMENTAL HEA I Into: <br /> Rancho Cucamonga, <br /> DEPARTMENT INSURER E: <br /> NSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REV13ION 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 /> N EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> TYPE OP INSURANCE P YNUM R LICY EF CY UWrs <br /> A X COMMEIICW.GENERAL LIABILITY <br /> EACH OCCURRENCE B 51000,00 <br /> CJAIMSMpDE a OCCUR ►ACE305425 07101120161 O7/01I2017 PREMISES ,a occlmarce B 300,00 <br /> MED EXP(Any ons Person E 25,00 <br /> PERSONAL A ADV INJURY f 01000,00 <br /> GErL AGGREGATE UNIT APPLIES PER: GENERAL AGGREGATE $ 8,tb16, <br /> om <br /> POLICY T j� D LOC <br /> PRODUCTS-COMPlOPAGO B 319O61 <br /> OTHER: <br /> $ <br /> AUTCOMILE LiAMLrfY O INEDINCL U <br /> E Ea accident B 1.000, <br /> ANY AUTO PHPK1514144 97/8+129+6 07/01/2017 BODILY INJURY(1swperaon) f <br /> ALL OWNED X SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per ecWRq) f <br /> X HIRED AUTOS X NON-OWNED <br /> AUf03 Per accident)AMA E <br /> S <br /> UYERELLA LAB X OCCUR <br /> A X EXCESa LAe CLAIMS-MADE EXC305426 EACH OCCURRENCE i 2,000,00 <br /> 9aro1ao16 mro+rsol7 AGGREGATE $ 2,000,00 <br /> DED X RETENTION 1 9 B <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LABIUTYX I STATUTE I ER <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N CA10002046161 00/01/2016 05/81/2017 <br /> OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT S 1,000,00 <br /> If(ManddWryie NMI <br /> nd EL DISEASE-EA EMPLOY 5 1,000,00 <br /> DESCRIPTION <br /> describe OF <br /> Drofes conal OPERATIONS bebw E.L.DISEASE-POLICY LIMB E 1,000,00 <br /> A Professional Uab• FACE305425 07/01/2016 0710112017 5,000,00 <br /> A Contractors Poll. PACE306425 07/01/2016 07/01/2017 5,000,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Raman Schedule,nwi be MleohedNmereepecehrequim) <br /> Proof of Coverage. <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 /> A <br /> UT <br /> HORIZED <br /> REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />
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