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INSTALL_2022
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0232482
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INSTALL_2022
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Entry Properties
Last modified
10/17/2024 4:26:39 PM
Creation date
4/19/2022 11:21:21 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2022
RECORD_ID
PR0232482
PE
2351 - UST FACILITY - 2481 COMPLIANT
FACILITY_ID
FA0003719
FACILITY_NAME
WEST LANE CHEVRON
STREET_NUMBER
4747
STREET_NAME
WEST
STREET_TYPE
LN
City
STOCKTON
Zip
95210
APN
10437010
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
Site Address
4747 WEST LN STOCKTON 95210
Tags
EHD - Public
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AcCERTIFICATE F LIABILITY INSURANCE DATE (MM,DDNYYY) <br /> AccW; 252BUl 11 /312020 <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 CONTACT <br /> Willis Towers Watson Midwest, Inc. NAME: <br /> 5700 W 112th Street, Ste , 100 PHONE 844.290-4908 IF No : <br /> Overland Park, KS 66211 ADDRESS: BBSicerts@locktonaffinity.com <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURER A : Ace American insurance Co. 22667 <br /> INSURED INSURER B : <br /> Barrett Business Services, Inc. <br /> UC/F LARRY & CLIFF ENTERPRISES, INC . DBA: LC SERVICES INSURERC : <br /> 3887 N VALENTINE <br /> FRESNO, CA 93722 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 /> IITR TYPE OF INSURANCE AODL SBR POLICY NUMBER POLICY EFF POLICY EXP <br /> MM D MM/Db LIMITS <br /> COMMERCIAL GENERAL LIABILITY <br /> EACH OCCURRENCE $ <br /> CLAIMS-MADE El OCCUR DAMAGE TO RENTEO PREMISES (Ee occurrence $ <br /> MED EXP (Any one person) $ <br /> PERSONAL B ADV INJURY $ <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICYF�j PRO- <br /> JECT LOC PRODUCTS - COMP/OP AGG S <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> ALL OWNED SCHEDULED ----- <br /> AUTOS AUTOS BODILY INJURY (Per accident) $ <br /> HIRED AUTOS pulp WNED PROPERTY DAMAGE $ <br /> Peraccident) <br /> $ <br /> UMBRELLA UAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MAOE AGGREGATE $ <br /> DEO RETENTION $ <br /> WORKERS COMPENSATION _ <br /> AND EMPLOYERS' LIABILITY Y l N X STATUTE ERH <br /> _...... <br /> A ANYPROPRIETOR/PXCLUDEfEXECtnIVE 068629962 11!1 !2020 1111 !2021 E.L. EACH ACCIDENT $ 2,000,000 <br /> (Mandatory In NH) EXCLUDED? � N / A _ <br /> (Mandatory In and E.L. DISEASE - EA EMPLOYE $ 2,000,000 <br /> Dif yes, describe under 2,000,0 <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space Is required) <br /> Policy Slate = CA <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Proof THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED <br /> Fresno, CA IN ACCORDANCE WITH THE POLICY PROVISIONS, <br /> AUTHORIZED REPRESENTATIVE <br /> © 19884014 ACORD CORPORATION . All rights reserved . <br /> ACORD 25 (2014/01 ) The ACORD name and logo are registered marks of ACORD <br />
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