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COMPLIANCE INFO_PRE 2019
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231532
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
10/5/2022 11:21:35 AM
Creation date
11/8/2018 9:47:10 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0231532
PE
2351
FACILITY_ID
FA0000185
FACILITY_NAME
CITY FOOD & LIQUOR
STREET_NUMBER
16470
STREET_NAME
CAMBRIDGE
STREET_TYPE
ST
City
LATHROP
Zip
95330
APN
19643032
CURRENT_STATUS
03
SITE_LOCATION
16470 CAMBRIDGE ST
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
Scanner
KBlackwell
Supplemental fields
FilePath
\MIGRATIONS3\C\CAMBRIDGE\16470\PR0231532\COMPLIANCE INFO.PDF
QuestysFileName
COMPLIANCE INFO
QuestysRecordDate
10/22/2012 8:00:00 AM
QuestysRecordID
131132
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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�L�. CERTIFICATE\3F LIABILITY INSURANCE 12 l/2 09 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> NUGEN & ASSOC INS SER INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> 10722 ARROW RTE, #116 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ! <br /> RANCHO CUCAMONGA, CA. 91730 <br /> 909 941-0167 INSURERS AFFORDING COVERAGE NAICN <br /> INSURED ISLAND PETROLEUM BUILDERS INC. RJSURERA WESTCHESTER SURPLUS LINES INS CO LEMAC <br /> CHUCK & JAN E COLLEY dba INSURERS GOLDEN RAGLE INSURANCE COMPANY <br /> 7470 SVL BOX INSURER CSTATE FUND COMPENSATION INSURANCE <br /> VICTORVILLE, CA 92395-5113 INSURER D: <br /> 19091923-9373 INSURER E: <br /> COVERAGES <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 /> POLICIES,AGGREGATE LIMITSSHOWN MAY HAVE BEEN REDUCED BY PAIDCINMS. <br /> I L P L I Y TIVE POLICYEXPIRATI N <br /> LN1 ASI TYPEFIN POLICY NUMBER DAT MMOD DATErMMATDJYYI LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $2,000,000.00 I <br /> X COMMERCWLGENERALLUIBILITY PREMISES Eo acpamlu 4 SD UUD•OO <br /> i CIAIMSMADE �OCCUR MEDE%P(MyanapHwn) s 5,000.00 <br /> A G220672300 05 06/09/09 06/09/10 PERSONAL&ADVINJURY $2,000,000.00 <br /> X POLLUTION LIAB GENERAL AGGREGATE $2,000,000.00 <br /> GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP)OPAGG $2,000,000.00 <br /> X POLICY 1E T LOC <br /> AVTOMOBRELMBRITY COMBINED SINGLE LIMN $1,000,000.00 <br /> X ANYAUTO (Eaap nl) <br /> II ALI OV.NEDAUTOS BODILYINJURY , <br /> X SCHEDULED AUTOS (Pw parw) f <br /> B X HIREDAUTOS BA 8447671 06/09/09 06/09/10 BODILYINJURY $ <br /> X NON-OVMEDAUTOS (POratGOUM) <br /> PROPERTY DAMAGE $ <br /> (ParaccidM) <br /> GARAGE LIABILITY AVfOONLY•EAACCIDENT S <br /> ANYAUTO OTHERTHAN EAACC S <br /> AvroONLY: AGO S <br /> EXCESSMUDRELLA LUIBILNY EACH OCCURRENCE S <br /> OCCUR r�CLAIMSMADE AGGREGATE S <br /> f <br /> DEDUCTIBLE f <br /> RETENTION f Is <br /> WORKERSCOMPENSATIONANO X T y aA 'I <br /> EMPLOYERS'LIABRN 624 0001313 08 11/01/09 11/02/10 E.L.EACHACCIDEM $1,000,001 00 <br /> ANI'PAOPRIETOWPAR1xEA,EaECNIVE <br /> `' OFFIGEPMEMBER UIXUIM07 <br /> n L.aalvmpmtlar EI DISEASE•EA EMPLOYE $1,000,000.00 <br /> I SPECIµPROVISIONSD EL DISEASE•POLICY LIMB I S1,000,000.00 <br /> B OTHER PROPERTY CBP 8447771 06/09/09 06/09/10 VALUE$77,000.DED$1000 <br /> INLAND/MARINE I I ALL RISK j <br /> ( RENT/LEASED E UI UE 100 000. <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT)SPECIAL PROVISIONS <br /> EVIDENCE OF INSURANCE I <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI <br /> ISLAND PETROLEUM BUILDERS INC DATE THEREOF,THE ISSUING INSURERYACENDEAVOR TO MAIL30 GAYS NRITTEN <br /> 7470 SUI' BOX NOTICE TO THE CERTIFICATE HOL ED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> VICTORVILLE CA 92392 IMPOSE NO OBLIGATION OR LI IL a ANY KIND UPON THE WSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD26(2001108) OACORD CORPORATION 1989 <br />
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