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WP0039455
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039455
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Entry Properties
Last modified
9/11/2019 11:05:39 AM
Creation date
9/6/2019 3:25:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039455
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
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EHD - Public
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FARWCOR-01 EBRITO <br /> ACORO' CERTIFICATE OF LIABILITY INSURANCE <br /> DATE 0911 1 12 01 YY) <br /> 09111/2018 <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. PHHO,"N,Ext):(949)623-1045 FAXAICNo>:(951)231-2572 <br /> 4695 MacArthur Court,Suite 600 <br /> Newport Beach,CA 92660 ED RIE ,cal.cpu@hubinternational.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> _ INSURERA:AIG Specialty Insurance Company 26883 <br /> INSURED -INSURER B:The First Libeily Insurance Corporation 33588 <br /> Farwest Corrosion Control Company INSURER C:Liberty 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. NOTWITHSTANDING 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 POLICY EFF POLICY EXPITP LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 <br /> CLAIMS-MADE FX] D <br /> OCCUR EG16542189 08/01/2018 08/01/2019 AAGETORENTED 300,000 <br /> PREMMISES Ea occurrence $ <br /> MED EXP(Any oneperson) $ 25'000 <br /> PERSONAL&ADV INJURY $ 1'000'000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2'000'000 <br /> POLICY F7X PRO- LOC PRODUCTS-COMP/OP AGG $ 2'000'000 <br /> OTHER: $ <br /> B AUTOMOBILE LIABILITY <br /> COMBINED <br /> acccidentSINGLE LIMIT $ 1,000,000 <br /> XANY AUTO AS6Z61036697208 08/01/2018 08/01/2019 BODILY INJURY Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> X AUTOS ONLY X AUOTOS ONE Pe�acEciCenDAMAGE $ <br /> A UMBRELLA LIAB X I OCCUR EACH OCCURRENCE $ 10'000'000 <br /> X EXCESS LIAB CLAIMS-MADE EGU16542191 08/01/2018 08/01/2019 AGGREGATE $ 10'000'000 <br /> DED X RETENTION$ <br /> C WORKERS COMPENSATION X <br /> AND EMPLOYERS'LIABILITY PSTATUTE ER <br /> YIN WC2Z61036697198 08/04/2018 08/04/2019 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/M EMBER EXCLUDED? N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1'000'000 <br /> If yes,describe under 1 000,000 <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 of San Joaquin THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Y q ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Environmental Health Department <br /> 1868 East Hazelton Ave. <br /> Stockton,CA 95205 AUTHORIZED REPRESENTATIVE <br /> F7'""""��� — <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
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