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COMPLIANCE INFO_2022
Environmental Health - Public
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EHD Program Facility Records by Street Name
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BENJAMIN HOLT
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2300 - Underground Storage Tank Program
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PR0231952
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
11/23/2022 11:08:46 AM
Creation date
1/19/2022 8:52:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0231952
PE
2351
FACILITY_ID
FA0003712
FACILITY_NAME
CHEVRON STATION #94275*
STREET_NUMBER
2905
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
09760004
CURRENT_STATUS
01
SITE_LOCATION
2905 W BENJAMIN HOLT DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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'4R CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br /> `.... . 12/17/2021 <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 policy( ies ) must have ADDITIONAL INSURED provisions or be endorsed . <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s ). <br /> PRODUCER CONTACT Catherine Montoya <br /> NAME: <br /> Milestone Risk Management & Insurance Services PHONE (949) 852-0909 FAX (949) 852- 1131 <br /> AIC No Ext)i AIC, No): <br /> License No . OB72766 ADDRESS: cmontoya@milestonepromise. com <br /> 8 Corporate Park, Suite 130 INSURER(S) AFFORDING COVERAGE NAIC # <br /> Irvine CA 92606 INSURERA : Everest Indemnity Insurance 10851 <br /> INSURED INSURER B : Everest Premier Insurance Co. 16045 <br /> Wayne Perry, Inc. INSURER C : <br /> 8281 Commonwealth Ave. INSURER D : <br /> INSURER E : <br /> Buena Park CA 90621 INSURER F : <br /> COVERAGES CERTIFICATE NUMBER : 21 -22 City 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAYBE 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 /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000, 000 <br /> CLAIMS-MADE � OCCUR PREMISES Ea occurrence S DAMAGE 10 HEN I ED 300, 000 <br /> MED EXP (Any one person) S 25. 000 <br /> A EF1ML00079211 12/31 /2021 12/31 /2022 PERSONAL & ADV INJURY $ 1 , 000. 000 <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 000, 000 <br /> POLICY PEC LOC PRODUCTS - COMP/OPAGG $ 21000, 000 <br /> OTHER: Employee Benefits $ 1 , 0001000 <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000 ; 000 <br /> Ea accident <br /> X ANY AUTO BODILY INJURY (Per person ) $ <br /> A AUTOS ONLY OWNED SCHEDULED EF1CA00044211 12/31 /2021 12/31 /2022 BODILY INJURY (Per accident ) $ <br /> AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident) <br /> UMBRELLA LIAB I X OCCUR EACH OCCURRENCE $ 10, 000, 000 <br /> A X EXCESS UAB 17 CLAIMS-MADE EFlC000052211 12/31 /2021 12/31 /2022 AGGREGATE $ 10, 000, 000 <br /> DED RETENTION $ $ <br /> WORKERS COMPENSATION X STATUTE ERH <br /> AND EMPLOYERS' LIABILITY YIN 1 , 000, 000 <br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE N CA10003737221 12/31 /2021 12/31 /2022 E. L. EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E. L. DISEASE - EA EMPLOYEE $ 11000, 000 <br /> If yes, describe under 1 , 000, 000 <br /> DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) <br /> *Evidence 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 /> *Evidence of Coverage* ACCORDANCE WITH THE POLICY PROVISIONS , <br /> AUTHORIZED REPRESENTATIVE <br /> ab, <br /> '1.f <br /> @ 1988 -2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />
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