My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2019
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
C
>
CAPITOL
>
6421
>
2300 - Underground Storage Tank Program
>
PR0231706
>
COMPLIANCE INFO_2019
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
10/5/2022 4:02:03 PM
Creation date
9/10/2020 2:35:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019
RECORD_ID
PR0231706
PE
2361
FACILITY_ID
FA0000485
FACILITY_NAME
FLAG CITY CHEVRON
STREET_NUMBER
6421
STREET_NAME
CAPITOL
STREET_TYPE
AVE
City
LODI
Zip
95242
APN
05532024
CURRENT_STATUS
01
SITE_LOCATION
6421 CAPITOL AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\kblackwell
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.
/
255
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
POLICYHOLDER COPY NE <br /> •COMPENSATIONP. O, BOX 8192, PLEASANTON, CA 94588 <br /> INSURANCE <br /> CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE : 11 - 01 - 2018 GROUP: <br /> POLICY NUMBER: 1308371 - 2018 <br /> CERTIFICATE ID: 173 <br /> CERTIFICATE EXPIRES: 11 - 01 - 2019 <br /> 11 - 01 - 2018 / 11 - 01 - 2019 <br /> CONTRACTORS STATE LICENSE BOARD NE LIC PERMIT# : 804904 <br /> INCEPTION DATE : 11 - 01 - 2018 <br /> PO BOX 26000 DONE <br /> SACRAMENTO CA 95826 -0026 <br /> This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br /> California Insurance Commissioner to the employer named below for the policy period indicated. <br /> This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br /> by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br /> with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br /> afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. <br /> Authorized Representative President and CEO <br /> EMPLOYER ' S LIABILITY LIMIT INCLUDING DEFENSE COSTS : $ 1 , 000 , 000 PER OCCURRENCE . <br /> ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS ' NOTICE EFFECTIVE 11 - 01 - 2016 IS <br /> ATTACHED TO AND FORMS A PART OF THIS POLICY . <br /> EMPLOYER <br /> CONFIDENCE UST SERVICES INC . NE <br /> 16250 MEACHAM RD <br /> BAKERSFIELD CA 93314 <br /> M0409 <br /> (REMm2014) PRINTED 10- 17 - 2018 <br />
The URL can be used to link to this page
Your browser does not support the video tag.