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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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KETTLEMAN
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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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OP ID 'S DATE(MMIODNYYY) <br /> ACORD CERTIFICAT OF LIABILITY INSURAN WALTo-z 09/25/08 <br /> THIS CERTIFICATE IS UED AS A MATTER OF INFORMATION <br /> PRooucER <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 Hudson Insurance Company <br /> INSURERS: Delos xnsurance Co. <br /> Walton Engineering, Inc. INSURER C: Hartford Insurance Co 34690 <br /> Peat BOX <br /> 1025 CA 95691 INSURER D: .tate a..w de.tion <br /> Sxnmssa0ee <br /> 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br /> LTR N$ TYPE OF INSURANCE <br /> POLICY NUMBER DATE MMIDD DATE MMIDD LIMITS <br /> TGENERALIABILfTYEACH OCCURRENCE $ 1,000,000 <br /> AERCIAL GENERAL LIABILITY PEC7001958 03/06/08 03/06/09 PREMISES(Ea.=rema $ 50,000 <br /> LAIMSMADE a OCCUR MED EXP(Any 0rre Person) $ 5,000 <br /> PERSONAL S ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 2,000,000 <br /> REGATE LIMB APPLIES PER: <br /> PRODUCTS-COMPIOPAGG 62,000,000 <br /> POuCY IX JED Loc Em Ben. 1,000,000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> B X ANY AUTO DPA5501792 03/06/08 03/06/09 (Ea accident) <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> (Per person) <br /> SCHEDULEDAUTOS <br /> HIRED AUTOS BODILY INJURY $ <br /> (Per accident) <br /> NON-OWNED AUTOS <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $. <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE ( $ 4,000,000 <br /> AX . 00CUR � CLAIMSMADE FXS7001959 03/06/08 03/06/09 AGGREGATE x4,000,000 <br /> $ <br /> DEDUCTIBLE <br /> s <br /> __RETENTION $ WCSTAIU M_ <br /> WORKERS COMPENSATION AND X ITORYLIMITS ER <br /> D EMPLOYERS LIABILITY 000713-4927-2008 . 10/01/08 10/01/09 E.L EACH ACCIDENT $ 1,000,000 <br /> ANY OFFICERIh1EMBERIEXCLUERIE ECUTNE <br /> E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> Ayes,tlasaibe u'der E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> SPECIAL PROVISIONS b.I. <br /> OTHER <br /> A Pollution/E&O PEC7001958 03/06/08 03/06/09 Poll/E&O 1,000,000 <br /> C Installation Fltr 57MSIZ6050 V10610803/06/09 , Inst Fltr 11000,000 <br /> DESCRIPTION OF OPERATIONS I LOCA I"NSI VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I 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 REPRESENTATIVES <br /> Dennis Cote' %ter <br /> ACORD 26(2001108) © ORD CORPORATION 1988 <br />
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