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COMPLIANCE INFO_2005-2007
Environmental Health - Public
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EHD Program Facility Records by Street Name
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JACK TONE
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1501
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2300 - Underground Storage Tank Program
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PR0505264
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COMPLIANCE INFO_2005-2007
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Last modified
7/28/2021 1:40:04 PM
Creation date
6/23/2020 6:56:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2005-2007
RECORD_ID
PR0505264
PE
2361
FACILITY_ID
FA0006672
FACILITY_NAME
FLYING J TRAVEL PLAZA #618*
STREET_NUMBER
1501
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
22811017
CURRENT_STATUS
01
SITE_LOCATION
1501 N JACK TONE RD
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0505264_1501 N JACK TONE_2005-2007.tif
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EHD - Public
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Client#: ORVISTAT <br /> ° I ' - CERTIFICATE LIABILITY INSURANCE DATE(MM/DDNYYY) <br /> 06/14/2006 <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> Commercial Lines Unit ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> ABD Insurance&Financial Services HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> 1039-A N.McDowell Blvd <br /> Petaluma,CA 94954-5507 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED INSURER A: National Liability& Fire Insurance <br /> Service Station Systems,Inc. INSURER B: <br /> 3224 Regional Parkway INSURER C: <br /> Santa Rosa,CA 95403 <br /> INSURER D: <br /> INSURER E. <br /> ;COVERAGES <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 NSR TYPE OF INSURANCE .. POLICY.NUMBER. POLICY EFFECTIVE POLICY EXPIRATION <br /> DATE MM/DD DATE MM/DD .LIMITS .. <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED <br /> CLAIMS MADE D OCCUR MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO- <br /> JECT 7 LOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANY AUTO EA ACC $ <br /> OTHER THAN <br /> AUTO ONLY: AGG $ <br /> EXCESWUMBAELLA LIABILITY :. : .: ' . . EACH OCCURRENCE $ : <br /> OCCUR CLAIMS MADE AGGREGATE $ <br /> $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> A WORKERS COMPENSATION AND 582138 06/04/06 06/04/07 X wC... 0TH• <br /> EEL <br /> EMPLOYERS'LIABILITY <br /> ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 <br /> OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE1$1,000,000 <br /> If yes,describe under <br /> SPECIAL PROVISIONS below E.L.DISEASE-POUCY LIMIT 1$1,000,000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br /> RE: License#485184 <br /> Evidence of Coverage. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> Contractors State License Board DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'An DAYS WRITTEN <br /> PO BOX 26000 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL <br /> Sacramento,CA 95826 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> REPRESENTATIVES. <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2001/08)1 of 2 #S843594/M843580 SERVISTAT SEW 0 ACORD CORPORATION 1988 <br />
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