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COMPLIANCE INFO_2020
Environmental Health - Public
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EHD Program Facility Records by Street Name
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T
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TRACY
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3725
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2300 - Underground Storage Tank Program
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PR0231417
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
12/31/2020 10:27:57 AM
Creation date
6/8/2020 10:00:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0231417
PE
2361
FACILITY_ID
FA0003780
FACILITY_NAME
TRACY SHELL*
STREET_NUMBER
3725
Direction
N
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
Zip
95376
APN
21217030
CURRENT_STATUS
01
SITE_LOCATION
3725 N TRACY BLVD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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�•�� DIMAMAI -01 MMORALES <br /> ACORO " DATE (MMIDDIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 1 /13/2020 <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 # 0525512 CONTACT <br /> Teague Insurance Ago, Ext), (619) 464-6851 ency , Inc. PHONE <br /> FAX <br /> 4700 Spring St., #400 E-MAIL (A/C, No): (619 ) 668-4715 <br /> La Mesa, CA 91942-0275 AODREss : info@teagueins . com <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURER A : Crum & Forster Specialty Insurance 44520 <br /> INSURED INSURER B : Everest Denali Insurance Company 16044 <br /> DiMaggio Maintenance, Inc. INSURER C : Insurance Company of the West 27847 <br /> PO Box 1637 INSURER D : <br /> Carlsbad, CA 92018 <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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> L I D D IDD DD 1 ,000, 000 <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCUR EPK129624 1 /11 /2020 1 /11 /2021 DAMAGE TO RENTED 50 ,000 <br /> PREMISES Ea occurrence $ <br /> MED EXP (Any oneperson) $ 51000 <br /> PERSONAL & ADV INJURY $ 1 ' 000' 000 <br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 ' 000'000 <br /> POLICY a JEC LOC PRODUCTS - COMP/OP AGG $ 2 ' 000' 000 <br /> F1 OTHER: $ <br /> COMBINED SINGLE LIMIT 1 , 000, 000 <br /> B AUTOMOBILE LIABILITY Ea accident $ '. <br /> ANY AUTO CF3CA00162-191 8/20/2019 8/20/2020 BODILY INJURY Perperson) $ <br /> OWNEDX AUTOS SCHEDULED <br /> AUTOS ONLY BODILY INJURY Per accident $ <br /> X HIRED X NON-OWNED PPROafcRd DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY <br /> $ <br /> A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 41000 ' 000 <br /> X EXCESS LIAB CLAIMS-MADE EFX114350 1 /11 /2020 1 /11 /2021 AGGREGATE $ 4,0001000 <br /> DED X RETENTION $ 0 $ <br /> C WORKERS COMPENSATION X STATUTE EORH <br /> AND EMPLOYERS' LIABILITY WSD603573003 1 /17/2020 1 /17/2021 11000 , 000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ E.L. EACH ACCIDENT $ <br /> OFFICER/MEMBEREXCLUDED? N / A 1 ,000, 000 <br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ <br /> If yesunder 1 ,0001000 <br /> EndescrDRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <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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