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INSTALL_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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PR0536555
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INSTALL_2014
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Last modified
11/25/2019 3:04:39 PM
Creation date
11/25/2019 11:13:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2014
RECORD_ID
PR0536555
PE
2351
FACILITY_ID
FA0020989
FACILITY_NAME
Arco. Am pm 83333
STREET_NUMBER
550
Direction
W
STREET_NAME
VALPICO
STREET_TYPE
Rd
City
Tracy
Zip
95376
CURRENT_STATUS
01
SITE_LOCATION
550 W Valpico Rd
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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KBlackwell
Tags
EHD - Public
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WENDAND-01 KDEDECKER <br /> DATE(MMIDD/YYYY) <br /> ,docorro CERTIFICATE OF LIABILITY INSURANCE <br /> l� 11122/2013 <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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> CONTACT <br /> PRODUCER NAME: <br /> Vantreo Insurance Brokerage PHONE 707 546-2300 FAX 707 546-2915 <br /> 100 Stony Point Rd,Suite 160 _AIC <br /> /MCANo Extl ) IA/C,No): ) <br /> Santa Rosa,CA 95401 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:Admiral Insurance Company 24856 <br /> INSURED INSURER B:Peerless Insurance Co. 24198 <br /> Wendt and Sons Construction INSURER c:State Compensation Insurance Fund 35076 <br /> Po Box 1403 INSURER D: <br /> Lodi,CA 957.41 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 CONTRACTOR 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 /> INSRADDLISUBR POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYW MMIDDIYYYY <br /> GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 <br /> A 4X $200 <br /> OMMERCIAL GENERAL LIABILITY FEIECC1591100 7/1/2013 7/1/2014 PREMISES Ea occurreD S 50,000 <br /> CLAIMS-MADE �OCCUR MED EXP(Any one person) S 5,000 <br /> Deductible PERSONAL&ADV INJURY $ 1,000,000 <br /> X I Per Occurence GENERAL AGGREGATE S 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 <br /> X POLICY PR0 n LOC $ <br /> AUTOMOBILE LIABILITY Ea acB..clie SINGLE LIMIT S 1,000,000 <br /> B X ANY AUTO BA8956730 7/1/2013 7/1/2014 BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE S <br /> HIRED AUTOS AUTOS <br /> Peraccidenl <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATEH $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION X WC STATU- OTH- <br /> TO <br /> AND EMPLOYERS'LIABILITY RY LIMITS R <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/❑N 9072992-13 10/1/2013 10/1/2014 E.L.EACH ACCIDENT S 1,000,000 <br /> OFFICERIMEMBER EXCLUDED? N I A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes.tlescribe under E.L.DISEASE-POLICY LIMIT S 1,000,000 <br /> DESCRIPTION OF OPERATIONS below <br /> B Equipment Floater CBP8950730 I 7/1/2013 7/1/2014 Rented/Leased Equip 150,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> «Evidence of Coverage>> <br /> CERTIFICATE HOLDER. CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> U 1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />
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