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COMPLIANCE INFO_2016
Environmental Health - Public
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EHD Program Facility Records by Street Name
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JACK TONE
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2300 - Underground Storage Tank Program
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PR0505264
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COMPLIANCE INFO_2016
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Last modified
8/11/2021 10:45:06 AM
Creation date
6/23/2020 6:57:24 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2016
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
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0505264_1501 N JACK TONE_2016.tif
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EHD - Public
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JONECOV-02 DAOACAYA <br /> A ® E(MW*DrYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE DATezare12412916 <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 INSUREP44 AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollay(les)must be andomed.N SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the <br /> certificate holder In lieu of such endomeme a. <br /> PRODUCER License 9 OES7768 CONTACT <br /> TOA Insurance Services 49)_297-5962 TAIL.sot:(949)297-5960 <br /> 130 VandaMZ <br /> Suite 250 Aoo <br /> Allen Viejo,CA 92656 --..__._.. <br /> INSURE AFFORDMG COVERAGE am# <br /> DMU—A:COIOnYbnumnceCom nl 39993 <br /> acrumRe:Phiiadei hieInd_emnttyInsuranceCom any 18058 <br /> Jones covey Group,Inc. Deaman c:Everest National lnsu_rance.Com a 10120 <br /> 9585 Lucas Reach Rd Ste 100 <br /> Rancho Cucamonga,CA 91730 <br /> a�URER P: <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 CONTRACTOR OTHER COMMENT 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 /> TYPE OF INSURANCE POLICY NUA%ER win <br /> A X coMMEmOALGENERAL DAaILTY IeifTENCE $ 5,000,00 <br /> pANRR DE®occua ACE305425 07101/2016 07/01/2017 EAgI OCG $ 300,00 <br /> MEDEXP s 25,000 <br /> PERSCNAIaADV*JURY S S,OED,O <br /> GENI.AGGREGATE MIT APPLIES PER: GENERAL AGGREGATE S 5,000,6 � <br /> POLICY[K❑PPRO.JECT ❑LOC PRODUCTS-COMP/OPAGG S _5,000,00.0 <br /> OTHER: & <br /> AUTOMOBaE LunLnY COMBINED MOLE LIMITS 1,000,0 <br /> B AAHNIRrEADUO D PHPKIS14144 0710112016 07/01/2017 aaoar mAm,r- <br /> TOSXAUIO BDY*AYW <br /> AUTOS pMTGgX-1 a HILm—) s <br /> S_— <br /> S I <br /> MORELLI,LMa x UR EAgN OCCURRENCE S 2,000,001 <br /> A X EXCESSLIAa 11CLAW.AVDE EXC306426 071011M6 07101/2017 AGGREGATE s 2,000, <br /> DEO X RETENTXms 0 <br /> VINARKERS COMPENSATION <br /> OYERa'LIAe1LITY X MAATUTE E <br /> C ANY ARrNEwExEcuTME YIN CA10002046161 05101/2016 0510112017 E.L.EACH ACCIDENT S 1,000,00( <br /> EiIGDNEDt a MIA <br /> MNH) E1.01SEASE-EAEa'LOYE S 1,000,00 <br /> SDE9y�.CRdNIS'TiON OF OS 0MO <br /> PERATPON 8 M1ow E.L.DISEASE-POLICY UNIT i 1,000r0 <br /> A Professional Llab. TACE305425 07101120.18 07/0712017 5,000,0 <br /> A ontractore Poll. ACE305425 0710112016 07/01/2017 5,000,0 <br /> DESCRWION OP oi—Tun"I LOCATIONS I VEHIDLM(ACOFA 191,AddftlonN Nmemse StlpWle,mry bre alHctad If mora dprra Is re 11d) <br /> Proof of coverage. - <br /> CERTIFICATE HOLDER CANCELLATION c- <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> IE �r <br /> TEXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. "$ t=) <br /> rr <br /> AUTHORIZED REPRESENTATIVE Q' <br /> ®1988.2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />
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