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COMPLIANCE INFO_2006-2010
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0516248
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COMPLIANCE INFO_2006-2010
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Last modified
10/19/2023 3:40:58 PM
Creation date
6/3/2020 10:00:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2006-2010
RECORD_ID
PR0516248
PE
2361
FACILITY_ID
FA0012532
FACILITY_NAME
CHEVRON STATION #209167
STREET_NUMBER
1234
Direction
E
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
22120016
CURRENT_STATUS
01
SITE_LOCATION
1234 E YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0516248_1234 E YOSEMITE_2006-2010.tif
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EHD - Public
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SERVISTAT <br /> ACORD., CERTIFICATE OF LIABILITY INSURANCE 1 DATE 6/51200(MMfDDNYYY) <br /> 7 <br /> LODUCER Commercial Lines Unit(707)769-2900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> ABD Insurance&Financial Services HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 1039-A N.McDowell Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Petaluma,CA 94954-5507 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED Service Station Systems,Inc. INSURER A: Oak River Insurance Company 34630 <br /> 3224 Regional Parkway INSURERS: <br /> INSURER C: <br /> INSURER D: <br /> Santa Rosa,CA 95403 <br /> INSURER E: <br /> COVERAGES <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 /> INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSRE TYPE OF INSURANCE POLICY NUMBER _QAI9JMMMDnM_ LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> I <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br /> om S lEa oc,unencel $ <br /> CLAIMS MADE DOCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $t GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ <br /> 17 <br /> POLICYPRO- LOC F JECT f <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO (Es accident) $ <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE <br /> (Per accident) $ <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ <br /> 7 OCCUR E-1CLAIMSMADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> A WORKERS COMPENSATION AND 2210020636071 6/4/2007 6/4/2008 X I WC STATU- JTORY I IMITOTH- <br /> S E8_ <br /> EMPLOYERS*LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICERIMEMBER EXCLUDED? <br /> Il'yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000.000 <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br /> Evidence of Coverage. <br /> CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> Chevron DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br /> cto AMCS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> PO Box 2020 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> Conway AR 72033 APTHQRME <br /> ACORD 25(2001108) 46341 0 ACORD CORPORATION 1988 <br />
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