My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
WP0039454
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
F
>
FORT DONELSON
>
0
>
4200/4300 - Liquid Waste/Water Well Permits
>
WP0039454
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/11/2019 11:15:03 AM
Creation date
9/6/2019 3:25:00 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039454
PE
4371
STREET_NUMBER
0
STREET_NAME
FORT DONELSON
City
STOCKTON
Zip
95209-
APN
09843036
ENTERED_DATE
3/14/2019 12:00:00 AM
SITE_LOCATION
0 FORT DONELSON
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\wng
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
13
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
FARWCOR-01 EBRITO <br /> ,a►CORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 0911112018 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER License#0757776 CONTACT Eunice Lee <br /> NAME: <br /> HUB International Insurance Services Inc. PHONE <br /> o,Ext):(949)623-1045 FAX 231-2572 <br /> 4695 MacArthur Court,Suite 600 <br /> Newport Beach,CA 92660 ADD"alEss:cal.cpu@hubinternational.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:AIG Specialty Insurance Company 26883 <br /> INSURED INSURERB:The First Liberty Insurance Corporation 33588 <br /> Farwest Corrosion Control Company INSURER C:Libe Mutual Fire Insurance Company 23035 <br /> 12029 Regentview Avenue INSURER D: <br /> Downey,CA 90241-3215 <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTVVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER PLTR OLICY EFF POLICY EXP LIMITS <br /> N rryYy) <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 <br /> CLAIMS-MADE FX�OCCUR EG16542189 08/01/2018 08/01/2019 DAMAGETORENTED $ 300,000 <br /> MED EXP(Any oneperson) $ 25'000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 <br /> POLICY 1XI TpcoT- E] LOC PRODUCTS-COMP/OP AGG 2,000,000 <br /> OTHER: <br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> (Ea accident)X ANY AUTO AS6Z61036697208 08/01/2018 08/01/2019 BODILY INJURY Per arson $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS <br /> SSVyN BODILY INJURY Per accident $ <br /> X AUTOS ONLY X ATOS ONLY PPeracEcRident AMAGE $ <br /> $ <br /> A UMBRELLA LU\B X OCCUR EACH OCCURRENCE $ 10'000'000 <br /> X EXCESS LIAR CLAIMS-MADE EGU16542191 08/01/2018 08/01/2019 AGGREGATE $ 10'000'000 <br /> DED I X I RETENTION$ 0 $ <br /> C WORKERS COMPENSATION X PER ORH- <br /> AND EMPLOYERS'LIABILITY Y/N WC2Z61036697198 08/04/2018 08/04/2019 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? F-] N/A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1'000'000 <br /> If yes,describe under 1000000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ' ' <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> RE:County of San Joaquin. <br /> For Information Purposes Only. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> County f San Joaquin THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Y Oq ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Environmental Health Department <br /> 1868 East Hazelton Ave. <br /> Stockton,CA 95205 AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
The URL can be used to link to this page
Your browser does not support the video tag.