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WP0040180
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4200/4300 - Liquid Waste/Water Well Permits
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WP0040180
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Entry Properties
Last modified
11/19/2024 1:59:19 PM
Creation date
12/19/2019 1:26:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0040180
PE
4372
STREET_NUMBER
2510
Direction
S
STREET_NAME
STATE ROUTE 99
STREET_TYPE
RD
City
STOCKTON
Zip
95205-
APN
17130024
ENTERED_DATE
10/11/2019 12:00:00 AM
SITE_LOCATION
2510 S HWY 99 W FR RD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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SALEENG-01 MMAZZA <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> DATE 11/29/2018 Y) <br /> 11129/2018 <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#OE02096 NC <br /> ONTACT <br /> DiBuduo&DeFendis Insurance Brokers,LLC PHHOMNNE — - -SAX - <br /> P.O.Box 5479 (AIC,No,Exq:(559)432-0222 1 (A/c,No):(559)431-7941 <br /> Fresno,CA 93755-5479 E-MAI <br /> L - -- <br /> _DDRESS: - -- --- ----- -- <br /> INSURER(S)_AFFORDING COVERAGE _ NAI_C# <br /> INSURER A:Valley ForgeInsurance Co 120508 <br /> INSURED INSURER B:Continental Casualty Company 20443 <br /> Salem Engineering Group,Inc. INSURER C:Continental Insurance Company 35289 <br /> 4729 W.Jacquelyn Ave. INSURER D:American Casualty.-Company_of Reading PA X20427 <br /> Fresno,CA 93722 <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 ',ADDL SUBR - POLICY POLICY EXP <br /> T TYPE OF INSURANCE IN D'WV POLICY NUMBER M /D YYYY)I IMMID12/YYYYI LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY II 2,000,000 <br /> EACH OCCURRENCE �$__ <br /> CLAIMS-MADE i X OCCUR X 6015693246 12/01/2018 112/0112019 PREM AGE <br /> Ea occurrence)__ $ 300'000 <br /> MED EXP(Any oneperson) $ 15'000 <br /> PERSONAL&ADV INJURY i $ 2'000'000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4'000000 <br /> POLICY X JE 0 LOC PRODUCTS-COMP/OP AGG $ 4'000'000 <br /> —— <br /> OTHER: <br /> 11 <br /> B AUTOMOBILE LIABILITY a aBINEDtS)INGLE LIMIT $ 11000,000 <br /> X ANY AUTO 6045473729 12/01/2018 12/01/2019 BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED _ - <br /> AUTOS ONLY i AUTOS BODILY INJURY(Per accident) $ _ <br /> HIRED NON-AWNED PROPERTY DAMAGE <br /> .AUTOS ONLY AUTOS ONLY are. <br /> r accident) _ $ <br /> C X UMBRELLA LIAB 1 X IOCCUR EACH OCCURRENCE $ 5_'000'000 <br /> EXCESS LIAB CLAIMS-MADE 6015893232 12/01/2018112/01/2019 1 5,000,000 <br /> DEC) X RETENTION$ 10,000 AGGREGATE_ $ <br /> _ <br /> RKERS <br /> PESATION <br /> D AND EMPLOYERS'LIABILIITY X OTH- <br /> ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 16020581635 12/01/2018 12/01/2019 E.L.EACH ACCIDENT 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? N/A <br /> $ <br /> (Mandatory In -- E.L.DISEASE-EA EMPLOYEE $ 1'000'000 <br /> If yes,describe under � I <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1'000000 <br /> B Prof./Pollution Liab AEH591895527 12/01/2018 12/01/2019 Each Claim 2,000,000 <br /> B Prof./Pollution Liab AEH591895527 12/01/2018 12/01/2019 lAggregate 4,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> **Actual Certificate to be issued upon request** <br /> Certificate Holder is named Additional Insured(including Completed Operations and Primary Non-Contributory Wording)as respects General Liability per <br /> attached blanket policy form CNA75079XX(10-16). <br /> **Professional/Pollution Liability deductible per claim-$25,000 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> **SAMPLE CERTIFICATE** THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED <br /> .LREPRESENTATIVE <br /> A \ <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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