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HomeMy WebLinkAboutCERT OF LIABILITY INSClient#: 565579 IDECO DATE (MhiIDD %YYYY) ACORDu CERTIFICATE OF LIABILITY INSURANCE 1011612013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A �bYE�T��� CONFERS ALTER THE COVERAGE AFFORDED Y THE POLICIES IS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY BELOW. THIS CERTIFICATE OF INSURANCE DOES F CATS HOLDER. ACONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE C ERT IMPORTANT: if the certificate holder is an ADDITIONAL INSURER, the poiicy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). rONTACT PRODUCER Hub International HUB InVI Insurance Sera. Inc. 180 N Riverview Dr, Ste 176 Anaheim, CA 92808 INSURED Ideco, Inc. 431 W. Blueridge Avenue Orange, CA 92865 VAME: Erinily 51iversparre 951 231.2572 PHONE 877 825-2681 A Na Ext) {AIC, No)• ,,,R,.,..,_... V+fVD (AIG E- MAIL Cal.CPU@hubinternational.com POLICYNUMBER FEIECC1049801 AD DRESS: INSURER S) AFFORDING COVERAGE NAIC # Admiral Insurance Company 44318 aysuR>+RA : Zurich American Insurance Compa 16535 INSURERS : INSURERC : Mercury Casualty Company 11908 INSURER D : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER! THIS IS TO CERTIFY THAT THE POLICIES RE O REIMENRT. TERM! OR CONDIT ON OF HAVE ANY CONTRACT OR THE OTHER DOCUMENT ND WITH RESPECTTHE O WHICH THIS PERIOD CERTIFICATE NOTWITHSTANDING ANY REQUIREMENT. CERTIFICATE_ MAY BE ISSUED OR MAY PERTAIN. � ©LiGIES.HLlMETS SHOVYNAM ORDER BY REDl1COED BY PAID DESCRIBED CLA CLAIMS. IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS O>= - 'poucY EFP POLICY �)T LIMITS TR TYpE OF INSURANCE INSR GENERALLIABILnY ,,,R,.,..,_... V+fVD POLICYNUMBER FEIECC1049801 MI%VUL II„ ii118l201310f18f201 ....v........ EACH OCCURRENCE PREMISES 1 a c�iccu� nce $ I $ 5c A X COMMERCIAL GENERAL LIABILITY a MEO EXP An one persat $ 5,' CLAJMS -MADE OCCUR PERSONAL & ADV INJURY $1, GENERAL AGGREGATE $ �, PRODUCTS - COMP /OP AGG $ 2, GEN'LAGGRECGATELIMITAPPLIES PER: $ PRO- LOG GGA0003869 210612613 121061201 COMBINED SINGLE LIMIT Ea aectdent) A AUTQiKOgt E LIABILITY BODILY INJURY (Per parson) $ X ANY AUTO BODILY INJURY (Per accident) $ ALLOWNED SCtiEDULED AUTOS AUTOS PROPERLY DAMAGE Par accident $ NON-OWNED X HIRED AUTOS X AUTOS $ FEIEXS1646801 011812013 10118/2014 EACHOCCURRENCE y $1 A UMBRELLA X OCCUR AGGREGATE $1 EXCESS CLAIMS -MADE $ DED ETENTION$ �O(�00 _•. 2f05l2013 02!051201 WCSTATU- OTM- B WORKERS COMPENSATION AND EMPLOYERS' LIABILI Y Y t N WG966042302 EL. EACH ACCIDENT $1 ANY PROPRIETORIPARTNERIEXECUTUE 1,41 A E.L. DISEASE - EA EMPLOYEE $1 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - POLICY LIMIT $1 If yes, describe under- _r.�..� DESCRIPTION OF OPERATiQNSI LOCATtONSJ VEHICLES (Attach ACORD 1o4, Additional Remarks sehaduls, if more space Is mqulred) RE: Gas Fueling Equipment Maintenance & Repair Services. directors and Circle K Stores, Inc. its subsidiaries, affiliates, partnerships, assigns, agents, employees, officers are additional insured in regards to general liability per attached form ECC -319 07!12. Insurance is Primary and Non- Contributory per attached form ECC -548- 07112. Waiver of Subrogation applies per attached form ECG - 320 - 07112. Waiver of subrogaton in regards to the Workers Compensation applies per (See Attached Descriptions) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Circle K Stores, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 255 E. Rincon Ste. 100 ACCORDANCE WITH THE POLICY PROVISIONS. corona, GA 92879 AUTHORIZED E2EPRESENTATIVE � L 0198a•2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD 6642 #S2477275fM2477269 THE FACE OF Candidate ID: Addre R5z N X` S. Ln cbLoREP`IJAC-j dft.OVN.p THAT CHANGES COLOR GRADUALLY AND EVENLY FROM DARK TO LIGHT WITH DARKER AREAS BOTH LEFT AND RIGHT cedifr.. 6�gr RIA Q. Al-9-IM-T V., p A N CA TION RES U bTV;,.--..PASS % 5/15/2 0 13 named examination. Your wallet card will be f of the month in which you tested. This certificz 01 14- a wall You mdylequest lVEN't'-ftie.ateJ -1,V: as well. This --t"' ur.-..q,,xam. Only one w zg r M t it within, 90 all X. days,o..yQ t t. �. t t t h WWWW-onlreque a 'no c arge. For m sting a t y Y. chang-061-iffname and/or ddress to -0. e y imp 'fla -h6tif P" VUE and it is exfd-`,-' I iortantZ Parson IC ri� P art Jv 6 • possibility of y6Q,,?,,,-'waU et. ca.. -r4�,%Aftor certificate not rece a Please contact 64il' -275-8 and address (name 301 and'110"C"' exam @ iccsafe.org with%%at", 49 M .,.-may require additional documentation). There may 66'a- al fee if a certification is p j .n additi.on d::..due to a misspelled name or incorrect address. p% A E." 41t W :APi*,%, M Ig %P, XM 1M X. 2 - .. ... .... 'N . ... .... . . Congratulations! You n, you by ICC within six weeks , for two years TION RES U bTV;,.--..PASS % 5/15/2 0 13 named examination. Your wallet card will be f of the month in which you tested. This certificz 01 14- a wall You mdylequest lVEN't'-ftie.ateJ -1,V: as well. This --t"' ur.-..q,,xam. Only one w zg r M t it within, 90 all X. days,o..yQ t t. �. t t t h WWWW-onlreque a 'no c arge. For m sting a t y Y. chang-061-iffname and/or ddress to -0. e y imp 'fla -h6tif P" VUE and it is exfd-`,-' I iortantZ Parson IC ri� P art Jv 6 • possibility of y6Q,,?,,,-'waU et. ca.. -r4�,%Aftor certificate not rece a Please contact 64il' -275-8 and address (name 301 and'110"C"' exam @ iccsafe.org with%%at", 49 M .,.-may require additional documentation). There may 66'a- al fee if a certification is p j .n additi.on d::..due to a misspelled name or incorrect address. p% A E." 41t W :APi*,%, M Ig %P, XM 1M X. 2 - .. ... .... 'N . ... .... . . Tech ical Traini Certification This certificate is issued in recognition that Al �i At4 2 3 i" r -lz. g.. • r r�,t � TchQlc�a�n�A�93:6:9 : , A.. ' has satisfactorily completed Veeder -Root Startup & Service Technician (Level 4) in TLS -3XX UST Monitoring Systems (including Secondary Containment Vacuum Sensing - CA only) Lewis IF,- Teahnicgf fraining Mana?ger- C) VEEDER -ROOT VEEDER -ROOT Certified •� Technician Tire bearer of this card has wm.esg* completed a mantfiadlxer tranmg oa lrse m the listed wuduct(s). Albert J. Queiros Technician #A29369 Expires 5/7/2014 (Intl. Secondary Containment Vacuum Sensing - CA only) You must contact TechnicalITrainingQgHbarmcom to confirm the current certification record for this person. 5/8/2012 Date of Issue 5/7/2014 Expiration Date i State Of California �AY�CONTRACTORS STATE LICENSE BOARD Consumer ACTIVE LICENSE Affairs ...,..744619 IDECO INC C 10 A HAZ Evkaffon we 01/31/2014 ew, CORP www-cslb. ca. gov