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COMPLIANCE INFO 2004 - 2008
Environmental Health - Public
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EHD Program Facility Records by Street Name
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E
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ELEVENTH
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1987
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2300 - Underground Storage Tank Program
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PR0517565
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COMPLIANCE INFO 2004 - 2008
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Last modified
11/19/2024 10:19:31 AM
Creation date
2/28/2019 4:21:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2004 - 2008
RECORD_ID
PR0517565
PE
2361
FACILITY_ID
FA0013503
FACILITY_NAME
SAFEWAY FUEL CENTER #2600
STREET_NUMBER
1987
Direction
W
STREET_NAME
ELEVENTH
STREET_TYPE
ST
City
TRACY
Zip
95376
CURRENT_STATUS
01
SITE_LOCATION
1987 W ELEVENTH ST
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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ACORD CERTIFICA1 E OF LIABILITY INSURANCE OP ID �_DATE(MM/DD/YYYY) <br />ABLEM-1 09/27/07 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />George Petersen Ins Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />P. O. Box 3539 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />627 College Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Santa Rosa CA 95402 <br />Phone:707-525-4150 Fax:707-525-4175 <br />INSURED <br />Able Maintenance, Inc. <br />3224 Regional Parkway <br />Santa Rosa CA 95403 <br />I.1vvr_rwvr=a <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A: Redwood Fire & Casualty Ins Co <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <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 W HICH 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 />N5K <br />LTR <br />A001 <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE POLI Y EXPIRATI N <br />DATE MMIDD/YY DATE MMIDDIYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />COMMERCIAL GENERAL LIABILITY <br />PREMISES (Ea occurence) $ <br />CLAIMS MADE F7OCCUR <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ <br />POLICY 7 PRO LOC <br />JECT <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ <br />ANY AUTO <br />(Ea accident) <br />ALL OW NED AUTOS <br />BODILY INJURY <br />SCHEDULED AUTOS <br />(Per person) $ <br />HIRED AUTOS <br />BODILY INJURY $ <br />NON -OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />ANY AUTO <br />OTHER THAN EA ACC $ <br />AUTO ONLY: AGG $ <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />OCCUR CLAIMS MADE <br />AGGREGATE $ <br />$ <br />DEDUCTIBLE <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION AND <br />X TORY LIMITS ER <br />A <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />W7A35050 <br />10/01/07 <br />10/01/08 <br />E.LEACH ACCIDENT $ 1000000 <br />E.L. DISEASE - EA EMPLOYE $ 1000000 <br />OFFICER/MEMBEREXCLUDED? <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT $1000000 <br />SPECIAL PROVISIONS below <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />*Cancellation - except 10 day notice for non-payment of premium/non <br />reporting of payroll. Employers Liability Limit $1,000,000. (per <br />accident/aggregate policy limit) <br />Proof of Insurance. <br />I.CtC 11r'Il.A 1 t r1ULUrM L;ANL;tLL.A 1 IUN <br />Service Station Systems <br />680 Quinn Ave <br />San Jose CA 95112 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN <br />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 />REPRESENTATIVES. <br />(32 <br />ACORD 25 (2001/08) © ACORD <br />
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