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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 SiDATE(h4M1DD/YYYY) <br />WALTO-2 09/29/09 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <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 A: SeaBright Insurance Co <br />INSURER B: <br />----- Walton Engineering, Engineering, Inc. INSURER C: <br />P.O. BOX 1025 INSURER D: <br />West Sacramento CA 95691 — <br />INSURER E: <br />nnVFRAGES <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 INSRO TYPE OF INSURANCE <br />POLICY NUMBER POLI EFFECTIVE <br />DATE (MM/DD <br />POLICEXPIRATION <br />DATE MM1DD/YY) <br />LIMITS <br />GENERAL LIABILITY <br />AUTHORIZED REPRESENTATIVE <br />Dennis Cote' <br />EACH OCCURRENCE $ <br />PREMISES(Ea occurence $ <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE OCCUR <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 ! JEC ' LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ <br />ANY AUTO i <br />(Ea accident) <br />BODILY INJURY <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) $ <br />BODILY INJURY $ <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE $ <br />I <br />(Per accident) <br />GARAGE LIABILITY j <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />i <br />ANY AUTO <br />f <br />AUTO ONLY: AGG $ <br />EXCESS/UMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />OCCUR J CLAIMS MADE 1 <br />AGGREGATE $ <br />S <br />I <br />I <br />$ <br />DEDUCTIBLE i <br />$ <br />RETENTION S <br />WORKERS COMPENSATION AND <br />x ,TORY LIMITS 1 ER <br />A <br />EMPLOYERS' LIABILITY BB 10 9 3 0 0 3 <br />10/01/09 <br />10/01/10 <br />E.L. EACH ACCIDENT S 1,000,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. DISEASE - EA EMPLOYEE $1,000,000 <br />OFFICER/MEMBER EXCLUDED? <br />It es, d <br />SPECIAescribe under L PROVISIONS below <br />E.L. DISEASE - POLICY LIMIT I $ 1,000,000 <br />OTHER <br />I <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. Evidence of <br />insurance only. <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 />Dennis Cote' <br />ACORD 25 (2001/08) © ACORD CORPORATION 1988 <br />
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