My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2020
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
K
>
KETTLEMAN
>
2448
>
2300 - Underground Storage Tank Program
>
PR0231948
>
COMPLIANCE INFO_2020
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
1/19/2022 1:20:11 PM
Creation date
6/18/2020 2:16:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0231948
PE
2361
FACILITY_ID
FA0003855
FACILITY_NAME
TESORO (SPEEDWAY) 68153
STREET_NUMBER
2448
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
05814001
CURRENT_STATUS
01
SITE_LOCATION
2448 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\kblackwell
Tags
EHD - Public
Jump to thumbnail
< previous set
next set >
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
272
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
A�® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) <br /> 3 / 3 / 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 be endorsed . if SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> NTCT <br /> PRODUCER NAME: Shale Pearson <br /> Leavitt United Insurance Services , Inc . PHONE ( 925 ) 395 - 2600 FAAIC No ; 1925 ) 287-0710 <br /> CA License # OJ02939 E-MAIL <br /> ADDRESS: shala-pearson@leavitt . com <br /> 2358 Maritime Dr , Ste 100 INSURERS AFFORDING COVERAGE NAIC # <br /> Elk Grove CA 95758 INSURER A : Admiral Insurance Company 24856 <br /> INSURED INSURER B : Travelers Property Casualty Company . 36161 <br /> Walton Engineering , Inc . INSURERC : State Compensation Insurance Fund 35076 <br /> P . O . BOX 1025 INSURERD : <br /> INSURER E : <br /> West Sacramento CA 95691 1 INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: 20 -21 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAYBE 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 SUER POLPOLICY NUMBER MM DI DIYYYY MMIDD/YYYY LIMITS <br /> CY EFF POLICY EXP <br /> LTR <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000 , 000 <br /> DAMAGE TO <br /> A CLAIMS-MADE ❑X OCCUR PREMISES (EaENTEoccurrence) $ 50 , 000 <br /> X Pollution Liability FEIECC1358706 3 / 6/2020 3/6/2021 MED EXP (Any one person) $ 5 , 000 <br /> X Professional Liability PERSONAL & ADV INJURY $ 1 , 000 , 000 <br /> GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 21000 , 000 <br /> POLICY a PRO F�j LOC PRODUCTS - COMP/OP AGO $ 21000 , 000 <br /> JE <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 , 000 , 000 <br /> Ea accident <br /> LB X ANYAUTO BODILY INJURY (Per person) $ <br /> ALL OWNED SCHEDULED 8108L785302 3/ 6/2020 3/6 /2021 130DILY INJURY (Per accident) $ <br /> AUTOS AUTOS <br /> NON OWNED PROPERTY <br /> accident) <br /> PERTDAMAGE $ <br /> X HIREDAUTOS X AUTOS P <br /> Uninsured motorist combined single $ 1 , 000 , 000 <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 10 000 000 <br /> A X EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 10 , 000 , 000 <br /> DED X RETENTION $ 0 FEIEXS1358806 3 / 6/2020 3/ 6 /2021 $ <br /> WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS' LIABILITY STATUTE ER <br /> YIN <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA <br /> E.L. EACH ACCIDENT $ 1 , 000 , 000 <br /> OFFICER/MEMBER EXCLUDED? <br /> C (Mandatory in NH) 9113339 10/ 1 / 2019 10/1 / 2020 E.L. DISEASE - EA EMPLOYEE $ 1 000 , 000 <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 , 000 <br /> B Inland Marine QT6608KB16207 3 / 6/2020 3/ 6/2021 Umit $ 300 , 000 <br /> Leased , Borrowed , Rented Deductible $2 , 500 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe attached if more space is required) <br /> Where required by written contract , Certificate Holder is Additional Insured with respects to the General <br /> Liability per attached policy endorsement form CG20370704 ; and with respects to the Auto , Additional <br /> Insured with Waiver of Subrogation and Primary and Noncontributory clauses apply when required by written <br /> contract per attached endorsement forms CAT3530215 and CAT4740216 . General Liability insurance is Primary <br /> and Noncontributory where required by written contract per attached endorsement form ECC5480712 . A <br /> separate Designated Construction Project General Aggregate Limit applies to each designated construction <br /> project of the Named Insured when agreed to and required under written contract per attached endorsement <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> To Whom it May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> I <br /> Shala Pearson / SHFRED <br /> I <br /> © 1988-2014 ACORD CORPORATION . All rights reserved. <br /> ACORD 25 (2014101 ) The ACORD name and logo are registered marks of ACORD <br /> j INS025 (201401) <br /> I <br />
The URL can be used to link to this page
Your browser does not support the video tag.