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COMPLIANCE INFO_2021
Environmental Health - Public
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EHD Program Facility Records by Street Name
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JOE POMBO
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2430
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2300 - Underground Storage Tank Program
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PR0506796
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
12/29/2021 10:14:49 AM
Creation date
10/5/2021 9:27:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0506796
PE
2361
FACILITY_ID
FA0007634
FACILITY_NAME
ARCO AM PM #82602*
STREET_NUMBER
2430
STREET_NAME
JOE POMBO
STREET_TYPE
PKWY
City
TRACY
Zip
95376
APN
214-020-200-000
CURRENT_STATUS
01
SITE_LOCATION
2430 JOE POMBO PKWY
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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�� ..� DIAM0 4 OP to: AS <br /> CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) <br /> 09/24/2021 <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 pollcy(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 to the <br /> certificate holder In lieu of such endorsement (s). <br /> PRODUCER ROANE cT P.J . Chawla <br /> Peck & Peck Insurance Brokers PHONE650.592.6591 AX Ne : 650.592-0404 <br /> 1724 Laurel Street Suite 225 E-MAIL <br /> San Carlos, CA 94070 ADDRESS* MYBROKER LISA.COM <br /> P.J. Chawla <br /> INSURER(S) AFFORDING COVERAGE NAIC S <br /> INSURER A : Mesa Underwritara Specialty <br /> INSURED Diamond Petroleum Services Inc INSURER B : State Compensation ins Fund 35076 <br /> Guadalupe Sanchez <br /> 3619 King Rd INSURER C : <br /> Antioch, CA 94509 INSURER D : <br /> 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 /> INSR S PO CY EFF POLICY EXP LIMITS <br /> TYPE OF INSURANCE POLICY NUMBER MR)D MMlDD <br /> A X COMMERctAL GENERAL t.IABtLfTY EACH OCCURRENCE $ 11000100 <br /> TAMAGE TO RENTED <br /> C AIMSAIADE FRI OCCUR MP0002008001026 09/09/2021 09/09/2022 PREMISES„ Ea occurrence $ 100900 <br /> MED EXP (Anyone person) $ 5000 <br /> PERSONAL & ADV INJURY S 10000000 <br /> NLAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE S 2,000000POLICY � PR0 El LOC PRODUCTS - COMP/OP AGG $ 20000,00 <br /> JECT <br /> $ <br /> OTHER <br /> COMBINED <br /> AUTOMOBILE LIABILITY eSINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY (Per person) S <br /> ALLOWNED SCHEDULED BODILY INJURY (Per accident) $ <br /> ROPERTY G <br /> AUTOS AUTOS <br /> Peracddent $ <br /> HIREDAUTOS AUTOS <br /> S <br /> UMBRELLALIAB H OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMSaMADE AGGREGATE $ <br /> OED RETENTIONS $ <br /> WORKERS COMPENSATION X I STATUTE I I ERH <br /> AND EMPLOYERS' LIABILITY <br /> B ANY PROPRIETORIPARTNER/EXECUTIVE YQ N 1 A 8214798-21 07/2112021 07/21/2022 E.L. EACH ACCIDENT $ 11000100 <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory In NH) E.LDISEASE - EAEMPLOYEE $ 10000000 <br /> Ifes E.LDISEASE - POLICY LIMIT E 10000000 <br /> DESCRIPTION OF OPERATIONS below <br /> A Property Coverage NIP8002008001026 09/0912021 09/09/2022 10000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br /> Proof of Insurance Only. <br /> CERTIFICATE HOLDER CANCELLATION <br /> BLANK4 <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 /> *'*Proof of Insurance*** <br /> AUTHORIZED REPRESENTATIVE <br /> © 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2014101 ) The ACORD name and logo are registered marks of ACORD <br /> I <br />
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