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INSTALL_2020
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0542283
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INSTALL_2020
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Last modified
3/1/2023 8:47:43 AM
Creation date
9/14/2020 10:51:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2020
RECORD_ID
PR0542283
PE
2351
FACILITY_ID
FA0024277
FACILITY_NAME
ARCO AMPM
STREET_NUMBER
2056
STREET_NAME
CRESTWOOD
STREET_TYPE
AVE
City
MANTECA
Zip
95336
CURRENT_STATUS
01
SITE_LOCATION
2056 CRESTWOOD AVE
QC Status
Approved
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EHD - Public
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T ® DATE(MM/DD/YYYY) <br /> AC"R" CERTIFICATE OF LIABILITY INSURANCE 9/20/2017 <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 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 to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAMEACT Lisa Suarez <br /> Truex Insurance Agency PHONEo. t( 209)477-1111 FNo. (209)478-0217 <br /> 4609 Quail Lakes Drive, Ste. 1 EMAIL ADDRESS:lsuarez@truexins.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> Stockton CA 95207 INSURER A:Scottsdale Insurance Company 41297 <br /> INSURED INSURERB:Travelers Prop Cas Co of Amer 25674 <br /> Wendt & Sons Construction, Inc. INSURER Midwest Employers Cas Co 23612 <br /> dba Wendt Construction INSURER D: <br /> PO BOX 1403 INSURER E: <br /> Lodi CA 95241 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER:CL1763018080 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 /> ADDL SUBR POLICY EFF POLICY EXP <br /> INSR <br /> TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> DAMA ETO RENTED 100,000 <br /> A CLAIMS-MADE Fx—1 rr <br /> OCCUR PREMISES Ea occuence $ <br /> X DOLLAR ONE DEFENSE VRS0002895 7/1/2017 7/1/2018 MED EXP(Any one person) $ 5,000 <br /> X DEFENSE OUTSIDE LIMIT PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: <br /> GENERAL AGGREGATE $ 2,000,000 <br /> X POLICY❑PRO -ECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> Employee Benefits S J-1000,000 <br /> OTHER: <br /> AUTOMOBILE LIABILITY EOaaccdant) NGLE LIMIT g 11 000,000 <br /> X ANY AUTO <br /> B BODILY INJURY(Per person) S <br /> ALL OWNED X SCHEDULED BA2G678400 8/15/2017 8/15/2016 BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> X HIRED AUTOS X AUTOS Per accident <br /> 1X 500 COMP DED X 500 COLL DED $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ _ $ <br /> POT <br /> WORKERS COMPENSATION X STATUTE ERH <br /> AND EMPLOYERS'LIABILITY YIN - <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 11000,000 <br /> OFROER/MEMBER EXCLUDED? ]NIA BNUWCO141715 10/1/2017 '10/1/2018 E.L.DISEASE-EA EMPLOYE $ 1,000,000 <br /> C (Mandatory In NH) <br /> If yes,describe under E.L.DISEASE-POLICY LIMIT S 11 000,000 <br /> DESCRIPTION OF OPERATIONS below <br /> A POLLUTION LIABILITY VRS0002895 7/1/2017 7/1/2018 CLAIMS MADE W/5,000DED: $1M/$2M <br /> A PROFESSIONAL LIABILITY VRS0002895 7/1/2017 7/1/2018 CLAIMS MADE W/5,000 DED: $1M/$2M <br /> i <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) <br /> License #723360 <br /> i <br /> Evidence Only <br /> Re: All California Locations <br /> i <br /> (SUPERCEDES CERTIFICATE ISSUED 6/30/2017; updates Work Comp renewal term.) <br /> CERTIFICATE HOLDER CANCELLATION <br /> I <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> CONTRACTORS STATE LICENSE BOARD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO BOX 26000 ACCORDANCE WITH THE POLICY PROVISIONS- <br /> SACRAMENTO, CA 95826-0026 <br /> AUTHORIZED REPRESENTATIVE <br /> James Watt/LISA <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are.registered marks of ACORD <br /> INS025(201401) <br />
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