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COMPLIANCE INFO_2013-2018
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231488
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COMPLIANCE INFO_2013-2018
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Last modified
8/12/2021 12:06:22 PM
Creation date
6/23/2020 6:49:38 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2013-2018
RECORD_ID
PR0231488
PE
2361
FACILITY_ID
FA0003910
FACILITY_NAME
H&M - BW #98
STREET_NUMBER
2501
STREET_NAME
JACKSON
STREET_TYPE
AVE
City
ESCALON
Zip
95320
CURRENT_STATUS
01
SITE_LOCATION
2501 JACKSON AVE
P_LOCATION
06
P_DISTRICT
005
QC Status
Approved
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SJGOV\rtan
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FilePath
\MIGRATIONS\UST\UST_2361_PR0231488_2501 JACKSON_2013-2018.tif
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EHD - Public
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-0101111111, a <br /> ,��®fzLI CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) <br /> 111412016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE <br /> AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE <br /> ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the poilcy(les)must be endorsed.If SUBROGRATION IS WAIVED, <br /> subject to the terms and conditions of the policy,certain Policies may require an endorsement.A statement on this certificate does <br /> not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER OnPoint Underwriting Inc. CONTACT NAME:Steven McComb <br /> .8390 E Crescent Pkwy,Suite 200 "` __ <br /> PHONE(A!C No Exl) (360)828 064Q FAX AI <br /> Greenwood Village,co 80311 -,--,-. .__...._ ,.__.._ .__ ....�..._. � C,NO)11(360)828-0699 <br /> EMAIL ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAlC# <br /> ._.._._._...._... ......,..��...w <br /> INSURER A ACE American In_.surance Company 22667 <br /> INSURED -� <br /> INSURER 8 <br /> 8aIT0Q Business Services,Inc.UCIF <br /> INSURER C: r., <br /> LARRY&CLIFF ENTERPRISES,INC. DBA LC INSURER D: <br /> SERVICES <br /> 3887 N VALENTINE <br /> INSURER F "" •-• - <br /> FRESNO,CA93722 __.._ _ _ ... . $ <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMEUA13OVE FOR THE POLICY PERIOD INDICATED. <br /> NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br /> ISSUES OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF <br /> SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE <br /> LTR.:. ADDL $UBR POLICY NUMBER POLICY EFF POLICY EXP <br /> INSR WVU (MMIDDNYVY) (MMIDDIYYYY) LIMITS <br /> GENERAL LIABILITY <br /> $ <br /> _...r,.COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE <br /> . D <br /> DAMAGE TO RENTED PREMISES(Ea $ <br /> CLAIMS-MADS ) <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENL AGGREGATE LIMIT APPLIES PER: 4fy <br /> GENERAL AGGREGATE <br /> POLICY PROD LOC Frac <br /> F1 41 <br /> ECT PRODUCTS-COMP/OPAGO g <br /> AUTOMOBILE LIABILITY $ <br /> COMBINED SINGLE LIMIT- <br /> ANY AUTO ..J r C7 !f <br /> • (Ea aoddenq - $ <br /> ALL OWNEDAUTOS11 SCHEDULED AUTOS BODILY INJURY(Per person) $. <br /> HIRED AUTOS NON-OWNEDAUTOS HEAL <br /> " H BODILY INJURY(Per accident) $ <br /> Vs »".1si_. E0s;_ r,.. � <br /> PROPERTY DAMAGE $ <br /> J��='� 1 ,mi s� $ <br /> =11E <br /> OCCUR EACH OCCURRENCE <br /> OCCURAGGREGATE <br /> TENTIONS <br /> A VIORKELFASIUTY RS COMPENSATION AND EMPLOYERS' YM RANG` 11/01/18 111002017 �/ YIC STATU- OTH- <br /> LtAB1UTORYLIMiTS <br /> ANY PROPRIETORIPARTNERIEXECUTIVE 048829521 ER <br /> OFFICERIMEMBER EXCLUDED? Y N 1 A E.L.EACH ACCIDENT $2,000,000 <br /> (Mandatory in NH)Iryee,descritp rnldor Covered Slates: <br /> CA E.L.DISEASE•EA EMPLOYEE $2,00D,000 <br /> . <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT <br /> $2,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Aaach ACORD 101,Additional Remarks SCl ONG.0 more space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> allOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> Proof of coverage EXPIRATION DATA THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br /> POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> Richard Poling <br /> 0)1988-2010 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2A3o/05) The ACORD name and logo are registered marks of ACORD. <br />
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