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COMPLIANCE INFO_2010-2018
Environmental Health - Public
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PR0231442
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COMPLIANCE INFO_2010-2018
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Last modified
8/10/2022 10:40:57 AM
Creation date
6/3/2020 9:49:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2010-2018
RECORD_ID
PR0231442
PE
2361
FACILITY_ID
FA0006441
FACILITY_NAME
QUIK STOP MARKET #5124*
STREET_NUMBER
505
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
217-260-21
CURRENT_STATUS
01
SITE_LOCATION
505 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231442_505 N MAIN_2010-2018.tif
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EHD - Public
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ACO&® CERTIFIC <br />AT OF LIABILITY INSURANCE OP ID S OATE(MMlODM'YY) <br />PRODUCER WALTO - 2 09Z29/09 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />TLB Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />3000 Oak Rd., Suite 210 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEN D OR <br />Walnut Creek CA 94597 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Phone:925-395-2600 Fax:925-287-0710 <br />INSURED <br />Walton Engineering, Inc. <br />P.O. Box 1025 <br />West Sacramento CA 95691 <br />INSURERS AFFORDING COVERAGE ' <br />NAIC # <br />INSURERA: SeaBright Insurance Co <br />INSURER B: I — <br />INSURER C: <br />INSURER D: <br />COVERAGES INSURER E: <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT 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 />LTR INSRd TYPE OF INSURANCE POLICY NUMBER POLI Y EF ECTIVE POLIC <br />I <br />GENERAL LIABILITY <br />I DATE MI'l DD/YY I DATE MM/DD/YY LIMITS <br />COMMERCIAL GENERAL LIABILITY i <br />I I EACH OCCURRENCE $ <br />CLAIMS MADE 0 OCCUR <br />i j UAMAGGE (-R-PREMISEoccurenco) I $ <br />I I MED EXP (Any one person) $ <br />I <br />PERSONAL & ADV INJURY $ <br />GENT AGGREGATE LIMIT APPLIES PER: <br />GENE RAL AGGREGATE $ <br />POLICY f7l, jE 1 LOC <br />I PRODUCTS - COMP/OP AGG $ <br />AUTOMOBILE LIABILITY <br />1 <br />ANYAUTO <br />( COMBINED SINGLE <br />I ALL OWNED AUTOS i <br />LIMIT <br />(Ea accident) S <br />_ <br />SCHEDULED AUTOS 1 <br />BODILY INJURY <br />HIRED AUTOS I <br />I (Per Person) $ <br />NON-OWNEDAUTOS <br />j <br />?BODILY INJURY <br />I I (Per accident) ) S <br />I PROPERTY DAMAGE <br />GARAGELIABILITY I (Per accident) $ <br />I <br />ANYAUTO i AUTO ONLY - EA ACCIDENT S <br />OTHER THAN EA ACC ' S <br />EXCESS/UMBRELLA LIABILITY AUTO ONLY: <br />I AGG S <br />OCCUR ,I� CLAIMS MADE ; EACH OCCURRENCE $ <br />I AGGREGATE $ <br />I DEDUCTIBLE r ------- <br />j S <br />RETENTION S I ' <br />i Ig <br />1 WORKERS COMPENSATION AND j S <br />A i EMPLOYERS' LIABILITY <br />I ANY PROPRIETOR/PARTNER/EXECUT(VE BB1093003X `TORY LIMITS ER <br />I OFFICER/MEMBER EXCLUDED? 1 1 9 10/01/10 <br />0 1 1 I E.L. EACH ACCIDENT <br />$11000,000I ff yes, describe under <br />SPECIAL PROVISIONS below I I E.L. DISEASE - EA EMPLOYEE S 1, 0 n 61000 <br />OTHER E.L. DISEASE - POLICY LIMIT 1 $ 1, 0 0 61000 <br />i <br />)ESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. <br />insurance only. Evidence of <br />CERTIFICATE HOLDER <br />TOWHOMI <br />To Whom it May Concern <br />k< lvo) <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH E EXPIRATIO <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AG ENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTA <br />Dennis Cote' JI, l'C .4��a., <br />©ACORD CORPORATION 1988 <br />
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