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COMPLIANCE INFO_PRE 2019
Environmental Health - Public
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2900 - Site Mitigation Program
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PR0537105
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COMPLIANCE INFO_PRE 2019
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Last modified
5/4/2021 4:23:12 PM
Creation date
5/4/2021 3:58:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0537105
PE
2950
FACILITY_ID
FA0021292
FACILITY_NAME
SEVERIN, JEFFERY L
STREET_NUMBER
2377
Direction
N
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95205
APN
11913017
CURRENT_STATUS
01
SITE_LOCATION
2377 N WATERLOO RD
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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LIMITS <br />Is 1,000,000 <br />100,000 <br />5,000 <br />PERSONAL & ADV INJURY 1,000,000 <br />GENERAL AGGREGATE 5 1,000,000 <br />PRODUCTS COMP/OF AGG $ 1,000,000 <br />EACH OCCURRENCE <br />-11AMAGE o MTN 1.3 PREMISES (Ea occurrence) <br />MED EXP (Any one parson) <br />SCHEDULED <br />AUTOS <br />NON•OWNED <br />AUTOS <br />X POLICY 1 .11ri LOC <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED <br />AUTOS <br />HIRED AUTOS <br />COmeiNtnINGLETI T (Ea accident) <br />SODILY INJURY (Per person) $ <br />BODILY INJURY Per accident) <br />PROPERTY DAMAGE accieleedj <br />DED <br />YIN <br />IA <br />I RET ENT ON $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS LIABILITY <br />ANY PROPRIETORWARTNEFV$XEG0TIVF <br />OFPICERMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe undo: <br />oEscRip'nON OF OPERATIONS below <br />wn-Wru.. I 0TH- <br />TORY LIMITS EE. <br />E L EACH ACCIDENT <br />E,i„ DISEASE - EA EMPLOYEES <br />E.L. DISEASE - POLICY LIMIT $ <br />SHOULD ANY OF THE ABOVE DESCRIBE <br />THE EXPIRATION DATE TH REOF, <br />ACCORDANCE WITH THE PO Y PROVI <br />POLICIES BE CANCELLED BEFORE <br />T E WILL BE DELIVERED IN <br />rl) 1988-2010 AC RD CORPO TION, All nghts reserved <br />06/13/2012 16:05 FAX 208 267 3941 <br />KAYSER INSURANCE <br />DATE (M w0D/Yrro <br />CERTIFIL.ATE OF LIABILITY INSURAE 6/13/2012 <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(Sj, AUTHORIZED <br />REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. <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 />IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />certificate holder in lieu of such endorsement(s). <br />I • <br />z <br />A CORD <br />NAME. <br />InEc, (208)267-5621 FAX (Atmo:(208)267-3941 <br />04-Es&kayserinsurance@hotmail.com <br />INSURER(a) AFFORDING COVERAGE NAIC A <br />INSURER A NAUTILUS/ALLIED GENERAL <br />INSURER B <br />INSURER C <br />INSURER <br />INSURER E <br />INSURER F <br />PRODUCER <br />KAYSER INSURANCE AGENCY, INC. <br />FOB 1538 <br />Bonners Ferry, ID 83805 <br />blend <br />INSURED <br /> <br /> ENVIRO ASSESSMENT, P.C. <br />DBA: ENVIRO ASSESS <br />PO BOX 1154 <br />BONNERS FERRY, ID 83805 <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 />NSF E NUMBR TYPE OF INSURANCE ABBL BUBB POLICY Err—traTITFEXP <br />LTR INEIR WVD POLICY (MIVIAJONYYY) (MIV/DO)YYYY) <br />GENERAL LIABILITY <br />X I COMMERCIAL GENERAL LIABILITY <br /> 1 CLAIMS-MADE X OCCUR <br />X PROFESSIONAL E&O <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />ECP200402700 11/03/2011 11/D3/2012 <br />UMBRELLA LIAB <br />OCCUR <br /> EACH OCCURRENCE <br />exCESS LIAB <br />CLAIMS-mADE <br /> AGGREGATE <br />DESCRIPTION OF OPERATIONS / LOCATIONS) VEHICLES (Attach ACORD101. Additional Remarks Schedule. It mom space krucluired) <br />WORKS ANYWHERE IN THE UNITED STATES AS A GEOLOGIST/ENVIROMENTALIST_ DOES PHASE I AND <br />PHASE II ENVIROMENTAL ASSESSMENTS. SAN JOAQUIN COUNTY ENVIR6MENTAL HEALTH DEPARTMENT <br />TO BE NAMED AS CERTIFICATE HOLDER. .1 <br />CERTIFICATE HOLDER <br />SAN JOAQUIN COUNTY ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />1868 HAZELTON AVE. <br />STOCKTON, CALIF. 95205-6232 <br />FAX: 209-468-0341 <br />ATT: JOHNNY YOAKUM <br />CANCELLATION <br />ACORD25 (2010/05) The ACORD name and logo are registered marks of ACORO
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