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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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GRANT LINE
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2300 - Underground Storage Tank Program
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PR0518288
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COMPLIANCE INFO_2016 - 2018
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Entry Properties
Last modified
8/28/2023 9:08:35 AM
Creation date
11/8/2018 10:21:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2016 - 2018
RECORD_ID
PR0518288
PE
2361
FACILITY_ID
FA0013810
FACILITY_NAME
COSTCO WHOLESALE #658
STREET_NUMBER
3250
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95377
CURRENT_STATUS
01
SITE_LOCATION
3250 W GRANT LINE RD
P_LOCATION
03
QC Status
Approved
Scanner
WNg
Supplemental fields
FilePath
\MIGRATIONS3\G\GRANT LINE\3250\PR0518288\COMPLIANCE INFO 2016 - PRESENT.pdf
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EHD - Public
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JONECOV-02 DADACAY <br /> ACRO' <br /> GEt KATE OF LIABILITY INSUIO NCE 4 7G00 DA 612 4120 1 6 <br /> THIS$ CERTIFICATE IS ISSUED ASA 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 MOLDER.. <br /> IMPORTANT: If the cattlf€caU holder is an ADDITIONAL INSURED,the policy(les)mast be endorsed, If SUBROGATION IS WAIVED,subject to <br /> the terms and condition*of the policy,certain poilcles may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder In flea of suet€eriftreernen <br /> PRODUCER LICetlss 0 QW769 K E17, <br /> IOA Insurance Seneiom 2- NE , <br /> 13!Mantis a95 29T-!3952 (949)257-5950 <br /> Suite 250 W r : <br /> Aliso Vldgp,CA 926M n E JNURUM AFFORDING COVERA" <br /> MAIC 11 <br /> r rti INSUNWA:Cialany hill urance Company 39M <br /> INSURED -l., �' <br /> INsueue :PhllstieNa ttdarrtn1€y�Insumce Company 18038 <br /> Jones Covey Group,Inc. ���� INsulmn c Evert rational Insurance Company 10120 <br /> 9a9SaaslEanagCAli1130�VIRONMl MALLHEALUmo: <br /> D�PI`:!� -NA��AT INaUIUEIIE: <br /> Uq F: <br /> C€VERAGE$ LIM <br /> RTIF1 ATE NUM R: REVI!ION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POUCEES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE WSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WMCH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED aY THE POLIcIEB DESCRIBED HEREIN 15 SUSJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND C0NOrRON3 OF SUCH POLICIES LIMCTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INTI TYP�DI<INeU1UKiICE <br /> PO CYN Ala R LIX[M <br /> A JXML @01ANAL LIABILITY EACH OCCURRENCE $ 5,000,wo <br /> Cf AIMSAfAl3E TOCCUR PAC.E305425 07101I2016 07101/2017 PREMISES a=amo $ 300,000 <br /> MED&XF fAn5!one peJs�nl $ 125',6000PERSONAL&A V INJURYCSWLAGGREGATELIMITAPPLtEr>P5R: GENERALAGGREGAlE SPOLICY�P� ❑LOC PRODU=-COMPIOP A00 <br /> OTHM I 1 $ <br /> AUTC1lYI0aRELIABILnY E RED NGLERI . 5 1,t100,flfl. <br /> $ 1 AUTO PHPK1514144 67101/20116 67LI111/2017 BODILY WJURY(Per pe wn) <br /> ALL OWNED X SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(plmacrhfent) $ <br /> X HfREQAE)TOS JC NONdHINED PR11=DAMAGE <br /> AUTOS eracsEdanl >; <br /> s <br /> U1rBRHLLA LLAT: x I=C'CUR Ei CH OCCURRENCE $ 2,t]Oa,Ofl <br /> A X excess LM CLAIMS-MAOIE EXC3d5426 0.716112016 QWUI12017 <br /> AGGREG1tTE a 2,000,00 <br /> rsEF� X RRFENTRQIvS 4 S <br /> WIRD GogPt "Imm <br /> AND EMPLOYOW LIARILITY X Sl'ATfJ.7'E ER <br /> C ANY PKOPRJMR]PARTNERSxECUTIVE <br /> YIN CA10002046161 0510.112016 05101=17 <br /> - <br /> El,EACHACCiDENTaSR EXCLUDED? Y❑ NfA Q <br /> OM <br /> oryNHj EL.0SEASE-EA�IPLQYE s 1,0fl ,O <br /> lfa%des;he wider <br /> E�SCRIFn0NOFCPERATICNSba1ow E,L.41SFASE-POLICY LIIIIT $ x,000,0 <br /> A Prefssstonal Llab. PACE306425 0710112016 07101/2017 5 <br /> (01 <br /> A Contractors Poll, PACE305425 0710.112016 G71MO17 5,00f3,afl <br /> DESCRIPTION OF OPERATIONS ILOCATION31 VEHICLES(ACCFW T61,Addlllonal Remarks achuduls,may be attached It more space to requirsd) <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 PRovisJONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Q 1988-2014 ACORD CORPORATION. All rights reserved. <br /> !CORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />
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