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FIELD DOCUMENTS FILE 1
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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2103
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3500 - Local Oversight Program
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PR0544591
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FIELD DOCUMENTS FILE 1
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Last modified
6/21/2019 2:26:57 PM
Creation date
6/21/2019 11:30:06 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 1
RECORD_ID
PR0544591
PE
3526
FACILITY_ID
FA0005220
FACILITY_NAME
CHEVRON #9-4054
STREET_NUMBER
2103
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12308029
CURRENT_STATUS
02
SITE_LOCATION
2103 COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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1d : 2e 0000 Deal .=% Renton 415-452-2193 <br /> aCERISSUE DATE(MMf;D <br /> o" <br /> rnooucER TICA^rE <br /> 3/14/D9 <br /> j THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS <br /> 100 Oak <br /> kS t r e-J 6 ASSOC. NO RIGHTS EXTEND OR ALTON THE CERTIFICATE ER THE COVERAGE FORDED BY THEDER.THIS RPOL GES BTE ELOW NOT <br /> AMEND, <br /> 100 Oek StrcQt - - .. <br /> Oak: Land,CA 94604 COMPANIES AFFORDING COVERAGE <br /> 415-465-3090 <br /> COMPANY <br /> CODE EuE•coa LETTER A Hartford Accident & Indemnity <br /> INSURED COMPANY <br /> 9 <br /> LETTER Illi no i s Excha nee <br /> F'ar_ ific F_nvlranmentat Grp . Inc - ' <br /> 1601 Civic Center Lr i ve, 6202 LETTTCOMERR "Y C <br /> Santa Clara EmPloyee Benefits Insurance <br /> CA 95050 °°"Eq Y D <br /> LETTER E _.. . <br /> TH ° {PI' ..:;�..; �.,!� �,ugid• x' J y�, y t ii , `:,i"`' .�� i -,I: ', Y :. <br /> THIS IS TQ CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED,NO7WITHS7ANDINO ANY REQUIREMENT TERM OR CONpIrIpN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED DR MAY PERTAIN,THE INBUMNCE AFFORDED BY THE BOUGIES DESCRIBED HEREIN 19 SUBJECT i0 ALL THE TERMS, <br /> Co <br /> EXCLU910N9 AND CONDITIONS Of SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN E O POLICIES <br /> D PAID CWM&, <br /> LTR TYPE OF INSURANCE I POLICY RMMIER POLICY EPPSCTIVE POLICY REpIRATVw .. <br /> _. DATE PYIDDIrY) DATE(MWDWM ALL UYITS w TND ICAYM <br /> OENERAL LIAEIL/YY -........_�.._......_. _...__ <br /> la x COMMERCIAL GENERAL LIABILITY 001-1077591, 2/18/89 2/1/90GEN".401GREGATE1t00 <br /> 0 <br /> DEx OCR _ Ew'CWMSMAPRSBCDpRETf A <br /> -. ..__. . <br /> OWNER-2/00MRAOT0R'0 W4T.I PEREONAL E ADVERnSINo RDURY P IFICL <br /> EACH OOOURRENDE Bis 000 T <br /> _.. ..._... .... _ <br /> . .,PETE DAMAOE..LM1LpH MIE1 <br /> �_..._- <br /> AMTOMOEILE LIAEIflY i •.- __•.-.�-.-. .._.... _. .._ .,_MEDICAL IXPEN$E <br /> .... _(N'Y OM PMMU 6 <br /> A X ANY AUTO ( 57UECZD4232 :COMBINED <br /> 4/01/89: 4/01/90 BDwLE f <br /> r11 <br /> ' x ALL OWNED AUTOS I : ;JJNLT..._ 1_•___,__..Q00 .. ;, �... .. <br /> _.SCHEDULED AUTOS BODILY <br /> INJURY i <br /> X-(HIRED AUTOS IP.T[.PR4�RI11. b: <br /> i .x..�NONAWNED AUTOSIDODILY <br /> .. ,INJURY . • <br /> GARAGE LIABILITY <br /> _Pi�Pn�I <br /> PROPERTY <br /> 'Y <br /> .... . ... ... ... .. .... (..... ........ . _. ... _... DAMAGE i i Y:o<TM <br /> EMM R LIAEMTY <br /> .". <br /> .. . <br /> EACH AOOREGAre • . <br /> . ...OTHER THAN UMBRELLA FORM M OCCURRENCES S <br /> WORKER'S COYPENSATgM ETATMTORY �, -.. t �"+a v. „• <br /> MCII .•,Z ACCIDENn <br /> EMPLOYERS'LUNUrr <br /> OTHER <br /> '.117194' 2/24/69 2/24/90".�.. . ... ?��Zy _ <br /> .. . .... __ --wl ....._ <br /> EGDPTION OP OPLMTiOME/LDGL ......_.__. ._..._._. _................._.._.�_,-.. <br /> JTW <br /> RTIfIdATIE OI.OLW'L t. <br /> ., .. �7�C+` .�4•. ;iii. <br /> �ly r <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BL CANCELLED BEFORE THE <br /> San Joaquin L_OC a l (•lea L th Dist . EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO <br /> P#O, Box 2009 MAIL_�OAyg WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE <br /> Stockton, CA, PZ201 LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR <br /> Attnt Ilerlu.. . c•...^__. <br />
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