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COMPLIANCE INFO_2006-2011
Environmental Health - Public
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EHD Program Facility Records by Street Name
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LOUISE
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1196
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2300 - Underground Storage Tank Program
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PR0231430
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COMPLIANCE INFO_2006-2011
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Last modified
1/30/2024 11:04:03 AM
Creation date
6/23/2020 6:48:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2006-2011
RECORD_ID
PR0231430
PE
2361
FACILITY_ID
FA0000848
FACILITY_NAME
QUIK STOP MARKET #2121
STREET_NUMBER
1196
Direction
W
STREET_NAME
LOUISE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
217-410-43
CURRENT_STATUS
01
SITE_LOCATION
1196 W LOUISE AVE
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231430_1196 W LOUISE_2006-2011.tif
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EHD - Public
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WALTO-2;;f <br />AGOR-D, 'CE TIFIC T F LIABILITY IIS LOP TO <br />DATE9L26IYY 7 <br />a9 26 a7 <br />PRODUCER ° <br />TLB insurance Services <br />3000 Oak Rd., Suite 210 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />POLICY NUMBER <br />Walnut Creek CA 94597 <br />Phone: 925-395-2600 Fax:925-287-0710 <br />INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />INSURER A. State compensation Insurance <br />INSURER B: <br />GENERAL LIABILITYEACH <br />INSURER C: <br />Walton Engineering, Inc. <br />P.O. Box 1025 <br />West Sacramento CA 95691 <br />INSURER D: <br />INSURER E: <br />UU V tKAl:C.7 <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 />LTR <br />ADM <br />NS <br />—POLICY <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />EFFECTIVE <br />DATE MWDDNY) <br />ON <br />DATE MM/DD/YY <br />LIMITS <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />GENERAL LIABILITYEACH <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />OCCURRENCE $ <br />PREMISES (Ea occurence) $ <br />Dennis Cote' <br />COMMERCIAL GENERAL LIABILITY <br />n benRn CORPORATION 1988 <br />MED EXP (Any one person) $ <br />CLAIMS MADE F—] OCCUR <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GEHL AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMPIOP AGG $ <br />POLICY PRO- <br />JECT LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ <br />(Ea accident) <br />ANY AUTO <br />ALL OWNED AUTOS <br />BODILY INJURY $ <br />(Per person) <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />BODILY INJURY $ <br />(Per accident) <br />NON -OWNED AUTOS <br />PROPERTY DAMAGE $ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />AUTO ONLY: AGG $ <br />ANY AUTO <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />OCCUR 71 CLAIMS MADE <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />A <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIAINUTY <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBEREXCLUDED? <br />7130004927-07 <br />10/01/07 <br />10/01/08 <br />X TOROYTTItITS ER <br />E.L. EACH ACCIDENT $ 1000000 <br />E.LDISEASE- EAEMPLOYE $ 1000000 <br />E.L. DISEASE - POLICY LIMIT $1000000 <br />Nes, describe under <br />SPECIAL PROVISIONS below <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />*10 days notice applies if cancelled for non-payment of premium. Evidence of <br />insurance only. <br />CERTIFICATE HULUtK <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />TOWHOMI <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 * DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />To Whom It May Concern <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE <br />Dennis Cote' <br />n benRn CORPORATION 1988 <br />ACORD 25 (2001108) <br />
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