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COMPLIANCE INFO 2010 - 2014
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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PR0231435
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COMPLIANCE INFO 2010 - 2014
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Last modified
8/5/2019 3:37:10 PM
Creation date
8/5/2019 11:56:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2010 - 2014
RECORD_ID
PR0231435
PE
2361
FACILITY_ID
FA0000916
FACILITY_NAME
7-ELEVEN INC #19976
STREET_NUMBER
1399
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21633034
CURRENT_STATUS
01
SITE_LOCATION
1399 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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^�dM& WALTO-2 OP ID: SH <br />"'`C " CERTIFIfflE OF LIABILITY INSUARNC <br />10/07/1E DATE(M07/1YYY) <br />1 <br />PRODUCER 925-395-2600 <br />TLB Insurance Services <br />3000 Oak ee ,Suite 210 <br />Walnut Cree <br />Walk, CA 94597 <br />59 <br />Dennis Cote' <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURED Walton Engineering, Inc. <br />P.O. Box T025 <br />West Sacramento, CA 95691 <br />INSURER A: Praetorian Insurance <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />:KaP1 a 7_TH �.'i <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 />INSR <br />ADVIL <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE POLICY EXPIRATION11JIM& <br />LIMITS <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Workers Compensation Unit <br />GENERAL LIABILITY <br />P.O. BOX 26000 <br />REPRESENTATIVES. <br />Sacramento, CA 95826 <br />EACH OCCURRENCE $ <br />DAMAGE TO RENTtu <br />PREMISES Ea occurenoe $ <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE E� OCCUR <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEN'LAGGREGATELIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ <br />POLICY PRO- <br />JECT F7 LOC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT $ <br />(Ea accident) <br />BODILY INJURY $ <br />(Per person) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per accident) $ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />ANY AUTO <br />AUTO ONLY: AGG $ <br />EXCESS I UMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />OCCUR F71 CLAIMS MADE <br />AGGREGATE $ <br />$ <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY /N <br />EE <br />ANY PROPRIETOR/PARTNER/XECUTIVY <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />OWC4000674 <br />10/01/11 <br />10/01/12 <br />X WC STATU- OTH- <br />TORY LIMITS PP <br />E.L. EACH ACCIDENT $ 1,000+00 <br />E.L. DISEASE - EA EMPLOYEE $ 1'000'00 <br />H es, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - POLICY LIMIT $ 1'00p00 <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. <br />License No.: 617238 <br />CERTIFICATE HOLDER CANCELLATION <br />CONTRA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br />Contractors State <br />License Board <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Workers Compensation Unit <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />P.O. BOX 26000 <br />REPRESENTATIVES. <br />Sacramento, CA 95826 <br />AUTHORIZED REPRESENTATIVE Dennis Cote' <br />ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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