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COMPLIANCE INFO_2009-2012
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231074
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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
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231074_4627 DA VINCI_2009-2012.tif
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EHD - Public
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ACORD CETIFICA OF LIABILITY INSURANCE OP,® $ DATE(MM/DD/YYYY) <br /> NIALTi 09 129/09 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> TLB snsurance Services HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 3000 Oak Rd. , Suite 210 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Walnut Creek CA 94597 <br /> Phone: 925-395-2600 Fax:925-287-0710 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED <br /> INSURER A: 8ndwcance American Spec xce cc <br /> INSURER B: Delos Insurance Co. <br /> Walton Engineering, Inc. INSURER C: SeaBrl ht Insurance Co <br /> P.O. Box 1025 <br /> West Sacramento CA 95691 INSURER D: Hartford Insurance Co 34690 <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 CONTRACTOR 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 INSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MMIDDlW LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE $ 1,000 000 <br /> A X I COMMERCIAL GENERAL LIABILITY $('C]01006001 QQ 03/06/09 03/06/10 PREMISES(Esoocurence) $50,000 <br /> CLAIMS MADE D OCCUR MED EXP(Any one person) $ 5,000 <br /> PERSONAL&ADV INJURY $ 1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 <br /> POLICY X I PRO- <br /> JECT LOC -Emp Ben. 1,000,000 <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> B X ANY AUTO DPA5501792@1 03/06/09 03/06/10 (Ea accident) S1,000,000 <br /> ALL OWNED AUTOS <br /> SCHEDULEDAUTOS ?BODILY INJURY $ <br /> I(Per person) <br /> ! HIRED AUTOS <br /> NON-OWNED AUTOS i BODILY INJURY(Par <br /> (Per accident) � <br /> i PROPERTY DAMAGE $ <br /> or accident) ; <br /> GARAGE LIABILITY- I AUTO ONLY-EA ACCIDENT '$ <br /> ANY AUTO ! <br /> {{J OTHER THAN EA ACC $ <br /> AUTO ONLY: AGO $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S 10,0 0 0,0 O O <br /> A X OCCUR CLAIMS MADE EXS101006002-00 03/06/09 03/06/10 AGGREGATE $ 10,000,000 <br /> DEDUCTIBLE $ <br /> RETENTION $ <br /> WORKERS COMPENSATION AND X I TORY LIMITS ! ER <br /> C EMPLOYERS'LIABILITY <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE 881093003 10101109 10/01/10 E.L.EACH ACCIDENT $ 1, 000,000 <br /> OFFICER/MEMBER EXCLUDED? <br /> If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 51,000,000 <br /> i OTHER <br /> I <br /> A Pollution/E&O ECC101006001-00 ' 03/06/09 03/06/10 Poll/E&O 1, 000,000 <br /> D Installation Fltr 57MSIZ6050 1 03/06/09 03/06/10 Inst Fltr 2,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> *10 days notice applies if cancelled for non-payment of premium. <br /> CERTIFICATE HOLDER CANCELLATION <br /> TOWHOMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br /> To Whom It May Concern 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 AGENTS OR <br /> REPRESENTATIVES, <br /> AUTHORIZED REPRESENTATNE <br /> Dennis Cote' r <br /> ACORD 25(2001108) ©ACORD CORPORA- -7 i <br /> TION 1988 <br /> I <br />
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