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COMPLIANCE INFO_2009-2012
Environmental Health - Public
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2300 - Underground Storage Tank Program
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COMPLIANCE INFO_2009-2012
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Last modified
3/1/2023 11:20:58 AM
Creation date
6/23/2020 6:41:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2009-2012
RECORD_ID
PR0231074
PE
2361
FACILITY_ID
FA0002541
FACILITY_NAME
7-ELEVEN INC #20632
STREET_NUMBER
4627
STREET_NAME
DA VINCI
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
11002003
CURRENT_STATUS
01
SITE_LOCATION
4627 DA VINCI DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\rtan
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FilePath
\MIGRATIONS\UST\UST_2361_PR0231074_4627 DA VINCI_2009-2012.tif
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EHD - Public
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DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> 8/17/2010 <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 /> PRODUCER Garrett/Mosier/Griffith/Sistrunk Ins. Services CONTACT NAME: ChariSe May <br /> 12 Truman PHONE(A/C,No,Ext): (949)559-3367 FAX(A/C,No): (949)559-3395 <br /> Irvine, CA 92620 E-MAIL ADDRESS: charisem arrett-mosier.com <br /> PRODUCER CUSTOMER ID#: <br /> www.garrett-mosier.com OB84519 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED Belshlre Environmental Services Inc. INSURERA: Zurich American Insurance Company 16535 <br /> 25971 Towne Centre Drive INSURER B: Steadfast Insurance Company 26387 <br /> Foothill Ranch CA 92610 INSURERC: <br /> INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 8059671 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 EFF POLICY EXP LIMITS <br /> LTR POLICY NUMBER MM/DDIYYYY MM/DDIYYYY <br /> A GENERAL LIABILITY GLO 4916038-08 6/14/2010 6/14/2011 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE T RENTED <br /> ✓ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 <br /> CLAIMS-MADE [z OCCUR MED EXP(Any one person) $ 5.00 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1.000.000 <br /> JECT <br /> POLICY ✓ PRO- LOC $ <br /> A AUTOMOBILE LIABILITY BAP 4916042-08 6/14/2010 6/14/2011 COMBINED SINGLE LIMIT <br /> ✓ ANY AUTO (Ea accident) $ 1,000,000 <br /> ALL OWNED AUTOS BODILY INJURY(Per person) $ <br /> SCHEDULED AUTOS BODILY INJURY(Per accident) $ <br /> ✓ HIRED AUTOS PROPERTY DAMAGE <br /> ✓ NON-OWNED AUTOS (Per accident) $ <br /> ✓ MCS-90 $ <br /> ✓ <br /> Pollution i ili $ <br /> B UMBRELLA LIAB ✓ OCCUR SEO 5337678-06 6/14/2010 6/14/2011 EACH OCCURRENCE $ 1,000,000 <br /> ✓ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 <br /> DEDUCTIBLE <br /> RETENTION $ N/A $ <br /> A WORKERS COMPENSATION Y/N WC5887150-00 4/1/2010 4/1/2011 ✓ NCYTA IT OTH <br /> AND EMPLOYERS'LIABILITY - <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE❑N N/A E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000.00 <br /> B Contractor's Professional Liability PEC 4916039-08 6/14/2010 6/14/2011 $1,000,000 per claim/agg;$25,000 Ded <br /> B Contractors Pollution Liabilily PEC 4916039-08 6/14/2010 6/14/2011 $1,000,000 per claim/a ;$25,000 Ded <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Evidence Only ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Griff Griffith <br /> ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br /> CERT NO.: 8059671 Charise May 8/17/2010 1:42:05 PM Page. 1 of 1 <br />
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