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COMPLIANCE INFO_2012-2017
Environmental Health - Public
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EHD Program Facility Records by Street Name
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GRANT LINE
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2300 - Underground Storage Tank Program
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PR0232469
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COMPLIANCE INFO_2012-2017
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Last modified
2/22/2021 4:12:21 PM
Creation date
6/23/2020 6:56:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2012-2017
RECORD_ID
PR0232469
PE
2361
FACILITY_ID
FA0003772
FACILITY_NAME
GRANT LINE SHELL*
STREET_NUMBER
2375
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
21402017
CURRENT_STATUS
01
SITE_LOCATION
2375 W GRANT LINE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0232469_2375 W GRANT LINE_2012-2017.tif
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EHD - Public
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DIMAMAI-01 JMCCOWAN <br />ACOR� CERTIFICATE OF LIABILITY INSURANCE <br />�••--� <br />DATE(MM/DDIYYYY) <br />01/20/2017 <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER License # 0525512 <br />Teague Insurance Agency, Inc. <br />4700 Spring St., #400 <br />CONTACT <br />NAME: <br />PHONE FAX <br />AAIC, No, Ext): (619) 464-6851 (A/C No):(619) 668-4715 <br />La Mesa, CA 91942 <br />ADORE : info@teagueins.com <br />INSURERS AFFORDING COVERAGE NAIC # <br />01/11/2017 <br />INSURER A: Admiral Insurance Co. <br />EACH OCCURRENCE $ 1,000,000 <br />INSURED <br />INSURER B: American Fire & Casualty 24066 <br />INSURER C: Insurance Company of the West 27847 <br />DiMaggio Maintenance, Inc. <br />INSURER D : <br />PO Box 1637 <br />Carlsbad, CA 92018 <br />INSURERE: <br />INSURER F: <br />PRODUCTS - COMP/OP AGG $ 2'000,000 <br />COVERAGES CERTIFICATE NUMBER: 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 LTRTYPE <br />OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ® OCCUR <br />FEIECC2334300 <br />01/11/2017 <br />01/11/2018 <br />EACH OCCURRENCE $ 1,000,000 <br />DAM AGE TO RENTED 100,000 <br />PREM ES Ea occurrence $ <br />MED EXP (Any oneperson) $ 5'000 <br />PERSONAL & ADV INJURY $ 1'000'000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ® JECT [:] LOC <br />OTHER: <br />GENERAL AGGREGATE $ 2'000,000 <br />PRODUCTS - COMP/OP AGG $ 2'000,000 <br />$ <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />AUTOS ONLY NON-OWNED <br />ONE <br />BAA56662042 <br />08/01/2016 <br />08/01/2017 <br />MBINED <br />Ea accd.nlSINGLE LIMIT $ 1,000,000 <br />BODILY INJURY Perperson) $ <br />BODILY INJURY Per accident $ <br />Peer accidentDAMAGE $ <br />A <br />X <br />UMBRELLA LIAB <br />EXCESS LIAB <br />X <br />OCCUR <br />CLAIMS -MADE <br />FEIEXS2334400 <br />01/11/2017 <br />01/11/2018 <br />EACH OCCURRENCE $ 4,000,000 <br />AGGREGATE $ 4,000'000 <br />DED I I RETENTION $ 0 <br />– $ <br />C <br />WORKERS COMPENSATIONX <br />ANDEMPLOYERS' LIABILITY <br />YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE J <br />NH) EXCLUDED? <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />WSD503573000 <br />01/17/2017 <br />01/17/2018 <br />PER OT <br />STATUTE ER <br />1,000,000 <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ 1'000'000 <br />1,000,000 <br />E.L. DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Proof of Insurance <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />VA <br />AI— <br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />
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