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COMPLIANCE INFO_2023
Environmental Health - Public
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EHD Program Facility Records by Street Name
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WATERLOO
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2300 - Underground Storage Tank Program
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PR0231761
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
9/25/2024 4:00:45 PM
Creation date
1/10/2023 9:08:44 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0231761
PE
2361
FACILITY_ID
FA0002347
FACILITY_NAME
ERNIES GENERAL STORE
STREET_NUMBER
4407
Direction
E
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
08710059
CURRENT_STATUS
01
SITE_LOCATION
4407 E WATERLOO RD
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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A�® CERTIFICATE OF LIABILITY INSURANCE DAT9/7i2o zYYY) <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 <br /> NAME: Pamella French <br /> Basi Insurance Services , Inc. WCPHONE E . 209-847-3065 FAX Ne : 209-848-4931 <br /> 1491 E G Street E-MAIL <br /> Oakdale CA 95361 ADDRESS : pamella ,french@hubinternational . com <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURER A : State Compensation Insurance Fund of California 35076 <br /> INSURED XPRES-1 INSURER B : <br /> Xpress Technical Services Inc <br /> XPress Auto Services , Inc INSURER C : <br /> P . O . Box 11160 INSURER D : <br /> Oakdale CA 95361 INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER: 1452509788 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 /> ?LTR TYPE OF INSURANCE JNSD WVDSUBR POLICY NUMBER MMIPOLDD/YYFYY MM/DD�YY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ <br /> DAMAGETO S ( RENTED <br /> CLAIMS-MADE OCCUR <br /> PREMISES Ea occurrence) $ <br /> MED EXP (Any one person) $ <br /> PERSONAL & ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> PRO- <br /> POLICY JECT LOC PRODUCTS - COMP/OP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY (Per person) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY Per accident $ <br /> JiNCEIR <br /> ELLALIAB OCCUR EACH OCCURRENCE $ <br /> ESSLCLAIMS-MADE AGGREGATE $ <br /> D RETENTION $ $ <br /> A WORKERS COMPENSATION 9286967-22 8/29/2022 8/29/2023 X PER OTH- <br /> AND EMPLOYERS' LIABILITY Y / NI STATUTE ER <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 , 000, 000 <br /> OFFICER/MEMBER EXCLUDED? N / A <br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000 <br /> If yes, describe under <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 110002000 <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) <br /> Information Purposes Only <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 /> ACCORDANCE WITH THE POLICY PROVISIONS . <br /> Evidence of Insurance AUTHORIZED EPRESENTATIVE <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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