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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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, ' 1 <br />ACOR- CERTIFICAI r✓ OF LIABILITY INSURANCt OP ID SH DATE(MM/DD/YYYY) <br />PRODUCER WALTO - 2 09/29/09 <br />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 />3 000 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 <br />Walton Engineering, Inc. <br />P.O. Box 1025 <br />West Sacramento CA 95691 <br />COVERAGES <br />TUC 01111 ICC --1 <br />ll., <br />INSURERS AFFORDING COVERAGE NAIC # <br />INSURER A: endurance American Spac ins co <br />INSURER B: Delos Insurance Co. <br />INSURER C: SeaBri ht Insurance Co <br />INSURER D: Hartford Insurance Co 34690 <br />INSURER E: <br />ITHSTAN DING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED <br />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 />INSIR UDI <br />LTR <br />INSR <br />TYPE OF INSURANCE <br />POLICY NUMBERDATE <br />MM/DD/YY <br />DATE MM /DDS <br />LIMITS <br />GENERAL LIABILITY <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />ECC101006001-00 <br />03/06/09 <br />03/06/10 <br />EACH OCCURRENCE S 1, 000, 000 <br />[ X ] OCCUR <br />PREMISES(Eaoccuance $ 50,000 <br />MED EXP (Any one person) $ 51 000 <br />�CLAIMSE <br />i <br />PERSONAL BADV INJURY S 11000,000 <br />GENERAL AGGREGATE $2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGO S 2,000,000 <br />POLICY j{ ' PRO- <br />F71 <br />EMP Ben. 1,000,000 <br />JECT LOC <br />AUTOMOBILE LIABILITY <br />B <br />X ANY AUTO <br />DPASS01792@1 <br />03/06/09 <br />03/06/10 <br />COMBINED SINGLE LIMIT <br />(Ea accident) 5 1, 000,000 <br />ALL OWNED AUTOS <br />BODILY INJURY $ <br />(Per person) <br />SCHEDULEDAUTOS <br />HIREDAUTOS <br />I <br />-- <br />BODILY INJURY $ <br />(Per accident) <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE <br />(Per accident) $ <br />i <br />) <br />GARAGE ,LIABILITY • i <br />I <br />AUTO ONLY _-EA ACCIDENT ' $ <br />ANY AUTO ( <br />OTHER THAN EA ACC S <br />AUTO ONLY: AGO $ <br />EXCESS/UMBRELLA LIABILITY <br />A <br />X I OCCUR CLAIMSMADE <br />EXS101006002-00 <br />03/06/09 <br />03/06/10 <br />EACH OCCURRENCE $ 10 , 00 0, 0 00 <br />AGGREGATE <br />$ 10,000,000 <br />$ <br />DEDUCTIBLE <br />S <br />RETENTION S <br />S <br />WORKERS COMPENSATION AND <br />_ <br />C EMPLOYERS' LIABILITY X ITORY LIMITS ER <br />gg 10 9 3 0 0 3 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE 10101109 10/01/10 E.L. EACH ACCIDENT $ 1,000,000 <br />OFFICERIMEMBER EXCLUDED? <br />I( yes, describe under E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />SPECIAL PROVISIONS below I I <br />E.L. DISEASE - POLICY LIMIT I 5 1,0n0,000 <br />OTHER <br />A Pollution/E&O ECC101006001-00 1: 03/06/09 03/06/10 Poll/E&O 11000,000 <br />D Installation Fltr 457MSIZ6050 03/06/09 03/06/10 Inst Fltr 2,000,000 <br />DESCRIPTION <br />OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. <br />CFRTIFI('ATF HOI r)P:P <br />�.vcwa i wiv <br />TOWHOMI 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 />To Whom It May Concern 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 />ACORD 25 (2001/06) Dennis Coter o-& <br />© ACORD CORPORATION 1988 <br />
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