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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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ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID SDATE(MM/DD/YYYY) <br />T <br />WALTO-2 <br />09/29/09 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />POLICY EXP RATI <br />DATE MM/DDIYY <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />TLB Insurance Services <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />3000 Oak Rd., Suite 210 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Walnut Creek CA 94597 <br />Phone: 925-395-2600 Fax:925-287-0710 <br />INSURERS AFFORDING COVERAGE NAIC# <br />4NSURED <br />INSURER A: Rndurance merican Spee Ins Co <br />INSURER B: Delos Insurance Co. <br />03/06/09 <br />INSURER C: SeaBright Insurance Co <br />Walton Engineering, Inc. <br />INSURER D: Hartford Insurance Co 34690 <br />P.O. Box 1025 <br />West Sacramento CA 95691 <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 <br />POLICY NUMBER P ICY EFFECTIVE <br />NSR TYPEOFINSURANCE DATE MM/DD/YY <br />POLICY EXP RATI <br />DATE MM/DDIYY <br />LIMITS <br />REPRESENTATIVES. <br />GENERAL LIABILITY <br />AUTHORIZED REPRESENTATIVE <br />t <br />Dennie Cote' <br />EACH OCCURRENCE $ 1,000,000 <br />A i <br />X COMMERCIAL GENERAL LIABILITY <br />ECC 1010 0 6 0 0 1- 0 0 <br />03/06/09 <br />03/06/10 <br />PREMISES (Ea occurence) $ 50,000 <br />! <br />CLAIMS MADE OCCUR <br />MED EXP (Any one person) $5, 000 <br />PERSONAL &ADV INJURY $ 1, 000,000 <br />GENERAL AGGREGATE s2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG s2,000,000 <br />POLICYFXJEC LOC <br />Emp Ben. 1,000,000 <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT g 1, 000, 0 0 0 <br />B <br />X <br />ANY AUTO <br />DPA5501792@1 <br />03/06/09 i 03/06/10 <br />(Ea accident) <br />BODILY INJURY $ <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />HIRED AUTOS <br />I BODILY INJURY $ <br />NON -OWNED AUTOS <br />i (Per accident) <br />i PROPERTY DAMAGE j $ <br />(Per accident) <br />GARAGE LIABILITY - <br />- <br />AUTO ONLY - EA ACCIDENT I $ <br />OTHER THAN EA ACC $ <br />ANY AUTO <br />AUTO ONLY: AGO $ <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE $ 10,000,000 <br />A <br />X OCCUR �CLAIMSMADE <br />EXS101006002-00 <br />03/06/09 <br />03/06/10 <br />AGGREGATE $10,000,000 <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />X TORY LIMITS I I ER <br />C <br />EMPLOYERS' LIABILITY <br />BB 10 9 3 0 0 3 <br />10 / 01 / 0 9 <br />10/01/10 <br />E.L. EACH ACCIDENT $1,000,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. DISEASE - EA EMPLOYEE $ 1, 000 , 000 <br />OFFICERIMEMBER EXCLUDED? <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - POLICY LIMIT $1,000,000 <br />OTHER <br />A <br />Pollution/E&O <br />ECC101006001-00 <br />03/06/09 <br />03/06/10 <br />Poll/E&O 1,000,000 <br />D <br />I Installation Fltr <br />57MSIZ6050 <br />03/06/09 <br />03/06/10 <br />Inst Fltr 2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / 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 <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 />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />To Whom It May Concern <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />t <br />Dennie Cote' <br />ACORD 25 (2001/08) © ACORD CORPORATION 1988 <br />
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