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COMPLIANCE INFO 2008 - 2015
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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PR0506724
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COMPLIANCE INFO 2008 - 2015
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Entry Properties
Last modified
11/15/2023 10:12:19 AM
Creation date
11/8/2018 10:22:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2008 - 2015
RECORD_ID
PR0506724
PE
2361
FACILITY_ID
FA0007594
FACILITY_NAME
WINE COUNTRY STATION/7-ELEVEN
STREET_NUMBER
1111
Direction
E
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04931056
CURRENT_STATUS
01
SITE_LOCATION
1111 E KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Supplemental fields
FilePath
\MIGRATIONS3\K\KETTLEMAN\1111\PR0506724\COMPLIANCE INFO 2008 - 2015.PDF
QuestysFileName
COMPLIANCE INFO 2008 - 2015
QuestysRecordDate
6/27/2018 4:14:35 PM
QuestysRecordID
3926585
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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ACORD CERTIFICA-60F LIABILITY INSURAN& OP ID S DATE(MMMD/YYYY) <br /> WALTO-2 09/25/08 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> TLB Insurance Services HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 3000 Oak Rd. , Suite 210 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Walnut Creek CA 94597 <br /> Phone: 925-395-2600 Fax:925-287-0710 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: Hudson Insurance Company <br /> INSURER B: Delos Insurance CO. <br /> Walton Engineering, Inc. INSURER C: Hartford Insurance Co 34690 <br /> P.O. BOX 1025 INSURER O: stats Coodtaasatinn xns=x a <br /> West Sacramento CA 95691 <br /> MSURER 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LTR NS TYPE OF INSURANCE POLICY NUMBER DATE MM/D DATE MM/DDM' LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY FEC7001958 03/06/08 03/06/09 PREMISES Eaoccarence $ 50,000 <br /> CLAIMS MADE X]OCCUR MED EXP(My ane parson) $ 5,0 Q 0 <br /> PERSONAL B ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE s2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 <br /> POLICY X JPERCOT LOC Emp Ben. 11000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> B X ANY AUTO DPASS01792 03/06/08 03/06/09 IS'acal°ant) $ 1,000,000 <br /> ALL OWNED AUTOS - BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (PeraccideM) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACC IDEM $ <br /> ANY AUTO OTHER THAN EAACC $ <br /> AUTO ONLY'. AGO $ <br /> EXCESWUMBRELLALIABILITY EACH OCCURRENCE s4,000,000 <br /> A X OCCUR F-1 CLAIMSMADE FXS7001959 03/06/08 03/06/09 AGGREGATE $4,000,000 <br /> s <br /> DEDUCTIBLE $ <br /> _..RETENTION.. $ _ $ <br /> WORKERS COMPENSATION AND X I T0R'YTIVrr I ER <br /> D EMPLOYERS'LUIDLITY 000713-4927-2008 10/01/08 10/01/09 E.L.EACH ACCIDENT $ 1,000,000 <br /> ANY PROPRIETORIPARTNER/EXECUTIVE <br /> OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> We,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> SPECIAL PROVISIONS below <br /> OTHER <br /> A Pollution/3&O FEC7001958 03/06/08 03/06/09 Poll/E&O 11000,000 <br /> C Installation Fltr 57MSIZ6050 03/06/08 03/06/09 Inst Fltr 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> *10 days notice applies if cancelled for non-payment of premium. <br /> CERTIFICATE HOLDER CANCELLATION <br /> TOWHOMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYSWRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> TO Whom It May Concern IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATNE <br /> Dennis CO__ <br /> ACORD 25(2001108) @AtORD CORPORATION 1988 <br />
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