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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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HENRY LONG
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2900 - Site Mitigation Program
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PR0526314
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COMPLIANCE INFO
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Entry Properties
Last modified
2/21/2020 6:29:47 PM
Creation date
2/21/2020 3:08:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0526314
PE
2950
FACILITY_ID
FA0017804
FACILITY_NAME
MORINAKA
STREET_NUMBER
612
STREET_NAME
HENRY LONG
STREET_TYPE
BLVD
City
STOCKTON
Zip
95206
APN
16819006
CURRENT_STATUS
01
SITE_LOCATION
612 HENRY LONG BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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From:Dolores O'Bar At:D 8 D Fax ID: .To:Vane Date:5f31'7006 01:57 PDA Page:2 of 3 <br /> TWINLAB-01' OBDO <br /> TE(MMIDDly" <br /> ACORD, CERTIFICATE OF LIAB'UTY 114SUI01ANCE " °A 5/312006 . <br /> 'PRODUCER: (559)432-0222 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION <br /> DlBuduo&DeFendis Insurance Brokers,LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> License#0E02096. AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> P.O:BAx 5479 - -- <br /> Fresno;CA 93755-5479' INSURERS AFFORDING COVERAGE NAIL# <br /> INSURED The Twining Laboratories,Inc. INSURER A:State Compensation Insurance Fund <br /> Jack Darrah INSURER B: <br /> P O Box 1472 In1.uReR c: <br /> Fresno,CA 93721 <br /> INSURER D: <br /> .' INSU;ER E: <br /> COVERAGES <br /> THE'POLICIES.OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED'ABOVE FOR THE POLICY PERIOD IDIDICATED.NOTWITHSTANDING <br /> ANY.REQUIREMENT,TERM OR CONDMON OF ANY OF OR OTHER'DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND,CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br /> I SR t TYPE 0 INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRAl10N - - LIMITS <br /> MAM <br /> LTR <br /> DATEI <br /> GENERAL LIABILITY ! ` EACH OCCURRENCE S- <br /> ET <br /> COMMERCIAL GEIJERAL LIABILITI' - I PREtIISES�rt xcuren e; ' <br /> CLAIMS MADE aOCCUR i.• MEDEXPIAryxpPer`-onI S . <br /> PERSONAL 8 A' INtlURY <br /> .. I GENERALAGGREGATE'. f <br /> GEN-LAGGREGATE LIMIT.APPLIES PER: �; - 'f PRODUCTS-CONIP/OP'AGG. S " <br /> POLICY PRb LOC ` <br /> AUTOMOBIBE.L1A81LITY COMBIIEE SINSLELIW. f <br /> ANY AUTO I'. . (Ee eccide,t) <br /> .I — 1 <br /> .,.ALL O\MJEDAIl�OS' BOD'LY INJURY <br /> SCHEDULED AUTOS (Per Carso) <br /> HIREDArtOS I .' BO&L`,14J1.14Y <br /> NON-OWNED AOTOS ' (per ecddertl <br /> PROPERTY DMAAGE, <br /> . (Per•occidentl - <br /> •6ARAGELIABLL17'7 .. - AUiOCNL'!-EAACCiD'TR f ' <br /> ANY AUTO OTHER TRV EAACC 3 , <br /> AUTO CNL`: AGG S ' <br /> a fXCESS/UMBRELLA LIABILITY'.. EACHiGCCU_P.R9NCE <br /> • .00CUR CLAIMS MADE I : ; AGGREGA�'. S ' <br /> DEDUCTIBLE -- <br /> RETENTION •` I. g __ <br /> - I ' <br /> WORKERS COMPENSATION AND .;, + 'X SI ER <br /> EMPLOYERS'LYABILpy ,1742451.06. ' •51112006 ,, 511@Q07 E.r.rj^rHAcxIDENr F 1,000,00 <br /> OFF CECERIMEMBER.E LfOE1D7ECUTDiE - E.L.DI`$EASE-EA EMPLOYEE i 1,000,0 U . <br /> tfyes,degcrib4 under' •I 1,000,00 <br /> SPECIAL PROVISIONS below E.L.DISEASE'-F10LICY LIMIT S <br /> OTHER <br /> DESCRIPTION OF OPERATIONS I LOCATIONSI'VEHICLES l EXCLUSIONS ADDED BY ENDORSEMENT{SPECIALORDVISIONS .. <br /> 10 Day Notice of Cancella"n.11A.Event of Nan Payment of'Premium <br /> CERTIF`ICATE'HOLDER ' CANCELLAtION <br /> SHOULD ANYOF THE ABOVE DESCRIBED POLICIES 3E CANCELLED BEFORE THE EXPIRATION <br /> I?,\TE6iEREOF,7F ,!SSUINGINSURERWILI:END-=;VDRTO,AMAIL:''UD DAYS wRrMN <br /> '? NJT:CE TO THE CERwicATE ROCIDER NAMED TO TI IE LEFT,BUT FAILURE TO DJ SO SHALL ' <br /> For Liformation Only <br /> 1 - - IMPOSE NO,qBLIGATION OR.LIABILITY OF ANY KIND JPON THE INSURER,ITS AGENTS OR <br /> . " .. REPRESENTATNE§. <br /> AUTHORIZEO REPRESENTATIVE r <br /> ACORI3 25(20011013) J ACOAD'CORPOR4�TCON 1988 <br />
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