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WP0040164
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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WP0040164
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Entry Properties
Last modified
11/18/2019 10:21:03 AM
Creation date
11/18/2019 10:14:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0040164
PE
4372
STREET_NUMBER
16700
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330-
APN
19821019
ENTERED_DATE
10/8/2019 12:00:00 AM
SITE_LOCATION
16700 S HARLAN RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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____04N TWINLAB-01 CBOYD <br /> ACOR" DATE(MM/DD/YYYY) <br /> �� CERTIFICATE OF LIABILITY INSURANCE 09/26/2019 <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#OE02096 CONTACT <br /> NAME: <br /> DiBuduo&DeFendis Insurance Brokers,LLC PHONE ) FAX,No):(559)431-7941 <br /> P.O.Box 5479 (AIC,No,Ext):(559 432-0222 <br /> Fresno,CA 93755-5479 ADDRR : <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:State Compensation Insurance Fund 35076 <br /> INSURED INSURER B: <br /> Moore Twining Associates,Inc. INSURER C: <br /> P.O. Box 1472 INSURER D: <br /> Fresno,CA 93716 <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 EXP LIMITS <br /> T <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE E OCCUR DAMAGE TO RENTED <br /> PRE MISE Ea occurrence) $ <br /> MED EXP(Any oneperson) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY 1 PRa F-1LOCPRODUCTS-COMP/OP AGG $ <br /> OTHER: <br /> BINED <br /> AUTOMOBILE LIABILITY CO a.d..n1SINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> HIRED NON rNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per acadent $ <br /> UMBRELLA LAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> A WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN 923042219 05/01/2019 05/01/2020 T R 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? ❑ NIA <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/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> San Joaquin Count Environment Health THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> q Y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 1868 E.Hazelton <br /> Stockton,CA 95205 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />
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