My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2016
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
T
>
THORNTON
>
15237
>
2300 - Underground Storage Tank Program
>
PR0517272
>
COMPLIANCE INFO_2016
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/30/2020 10:41:44 AM
Creation date
6/23/2020 6:59:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2016
RECORD_ID
PR0517272
PE
2361
FACILITY_ID
FA0012979
FACILITY_NAME
FLYING J TRAVEL PLAZA #617
STREET_NUMBER
15237
Direction
N
STREET_NAME
THORNTON
STREET_TYPE
Rd
City
Lodi
Zip
95242
APN
02519014
CURRENT_STATUS
01
SITE_LOCATION
15237 N Thornton Rd
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0517272_15237 N THORNTON_2016.tif
Tags
EHD - Public
Jump to thumbnail
< previous set
next set >
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
384
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
0 <br /> JONECOV-02 DADACAYA <br /> DATE(MMfDD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE F6/24/2016 <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(les)must be endorsed. If 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 t0 the <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER License#OE67768 H ME:C <br /> IDA Insurance Services P IAIC,No, ;(949)297-5962 A No;(949)297-5960 <br /> 130 VantisFE-MAIL <br /> Suite 250ADDRESS: <br /> Aliso Viejo,CA 92656 DECZo <br /> INSURER(S) AFFORDING COVERAGE NAIC# <br /> INSURER A:Colony Insurance Company 39993 <br /> INSURED _ # iladelphia Indemnity Insurance Company 18058 <br /> m <br /> Jones Covey Group,Inc. VIRO r �INsuReRc:Everest National Insurance Company 10120 <br /> 9595 Lucas Ranch Rd Ste 100 t,gin i ® )INJURERD: <br /> Rancho Cucamonga,CA 91730 INSURER E <br /> INSURER F: <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 /> °HTR TYPE OF INSURANCE POLICY NUMBER MM ADDLSUBR DIYEYYYY MY EFF PM/DO EXP LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,0001 <br /> CLAIMS-MADE ®OCCUR PACE305425 07/01/2016 07/01/2017 DAMAGE TO R NT <br /> PREMISES Ea occurrence $ 300,00 <br /> MED EXP(Any one person) $ 25,00 <br /> PERSONAL&ADV INJURY $ 5,000,00 <br /> GEN.L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,00 <br /> POLICY®JECOT- ❑LOC PRODUCTS-COMPIOPAGG $ 5,000,00 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY EOMa"dentED °N L LIWIT $ 1,000,00 <br /> B ANY AUTO PHPK1514144 07/01/2016 07/01/2017 BODILY INJURY(Per person) $ <br /> ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ <br /> X AUTOS AUTOS <br /> X NON-OWNED PPReOPPEERd nDAMAGE $ <br /> HIRED AUTOS AUTOS <br /> UMBRELLA LIAB XJ OCCUR EACH OCCURRENCE $ 2,000,00 <br /> A X EXCESS LIAB CLAIMS-MADE EXC305426 07/01/2016 07/01/2017 AGGREGATE $ 2,000,00 <br /> DED X RETENTION$ 0 $ <br /> WORKERS COMPENSATION X <br /> AND EMPLOYERS'LIABILITY STATUTE ERH <br /> C ANY PROPRIETOR/PARTNER/EXECUTIVE TH- <br /> Y/N A10002046161 05/01/2016 05/01/2017 E.L.EACH ACCIDENT $ 1,000,00 <br /> OFFICERIMEMBER EXCLUDED? ® N I A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> A Professional Liab. PACE305425 07/01/2016 07/01/2017 5,000,00 <br /> A Contractors Poll. PACE305425 07/01/2016 07/01/2017 5,000,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space Is required) <br /> Proof of Coverage. <br /> CERTIFICATE HOLDER CANCELLATION <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 /> ' m r CIC <br /> ®1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD <br />
The URL can be used to link to this page
Your browser does not support the video tag.