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COMPLIANCE INFO 2013-2015
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0505867
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COMPLIANCE INFO 2013-2015
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Last modified
7/6/2020 4:40:19 PM
Creation date
11/5/2018 4:46:06 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2013-2015
RECORD_ID
PR0505867
PE
2361
FACILITY_ID
FA0007059
STREET_NUMBER
192
STREET_NAME
LATHROP
STREET_TYPE
Rd
City
Lathrop
Zip
95330
CURRENT_STATUS
01
SITE_LOCATION
192 Lathrop Rd
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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\MIGRATIONS\L\LATHROP\192\PR0505867\COMPLIANCE INFO 2013-2015.PDF
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ACO/ZO" <br />PRODUCER <br />TLB Insurance Services <br />CA License# OB82095 <br />3000 Oak Rd., Suite 210 <br />Walnut Creek CA 94597 <br />Dennis Cote' -existing <br />INSURED <br />19 • WALTO-2 OP ID: J <br />CERTIFICATE OF LIABILITY INSURANCE DATE(MM ODNYYV) <br />09/29/2015 <br />CA 95691 <br />Phone: 925.395-2600 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />INSURER A: Admiral Insurance Compa <br />INSURER B: Harford Casualty Insuranf <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />Pni IrIFS Ar:r;RFOATF LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />DDT <br />TYPE OF INMIRANCE <br />POLICY NUMBERDATECMM/DD <br />YY <br />POLICYEXPIRATION <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,00 <br />PREMISES Eacccurence $ 50,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />FEI-ECC-13587-02 <br />03/06/2015 <br />03/06/2016 <br />MED EXP (Any one person) $ 5,00 <br />CLAIMS MADE X OCCUR <br />PERSONAL &ADV INJURY $ 1,000,00 <br />GENERAL AGGREGATE $ 2,000,00 <br />GENL AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS-COMP/OP AGG $ 2,000,00 <br />Emp Ben. 1,000,00 <br />POLICY X PRO- LOC <br />JECT <br />D <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />WPA103022404 <br />03/06/2015 <br />03/06/2016 <br />COMBINED SINGLE LIMIT $ 1,000,00 <br />(Ea accident) <br />BODILY INJURY $ <br />(PER PERSON) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY $ <br />(PER ACCIDENT) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />(PER ACCIDENT) $ <br />D <br />D <br />X <br />Comp Ded-$1,000 <br />WPA103022404 <br />WPA703022404 <br />03106/2015 <br />09/06/2015 <br />03/06/2016 <br />03/06/2016 <br />X <br />Coll Ded-$1,000 <br />E LIABILITY <br />AUTOONLY-EAACCIDENT $ <br />OTHER THAN EA ACC $ <br />PGA <br />ANY AUTO <br />P <br />AUTO ONLY: AGO $ <br />GXCEBB / UMBRELLA LIABILITY <br />EACH OCCURRENCE $ 10,000,00 <br />AGGREGATE $ 10,000,00 <br />A <br />X OCCUR F_I CLAIMS MADE <br />FEI-EXS-13588-02 <br />03/06/2015 <br />03/08/2016 <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIErOR/PARTNERIEXECUTIVE YIN <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />Ifyes, describe under <br />SPECIAL PROVISIONS below <br />9113339.15 <br />10/01/2015 <br />10/01/2016 <br />1C WC STATU- OTH- <br />T R ER <br />E.L. EACH ACCIDENT $ 1,000,00 <br />E.L. DISEASE - EA EMPLOYE $ 1,000,00 <br />E.L. DISEASE -POLICY LIMIT $ 1,000,00 <br />OTHER <br />A <br />Pollution/E&O <br />FEI-ECC-13587-02 <br />03/06/2015 <br />03/06/2016 <br />POIVE&O 1,000,00 <br />B <br />Installation Float <br />57UUMZC1966 <br />1 03/06/2015 <br />03/06/2016 <br />1 Int Fltr 2,000,00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />•10 days notice applies if cancelled for non-payment of premium. <br />TOWHOMI SHOULDANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30" DAYS WRITTEN <br />To Whom It May Concern NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />ACORn 95 (9nn9m11 <br />AUTHORIZED REPRESENTATIVEDennis <br />©1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />101 <br />
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