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Home My WebLink About1520 20TH STREET (5)State of Californiar` for State Use Only State Water Resources Control Board I: Division of Financial Assistance p P.O. Box 944212 Sacramento, CA 94244 -2120 CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND S'T'ORAGE TANKS CONTAINING PETROLEUM i. I am required to denrnsuate Hmanccrl Respoa\ihility in the required anx)unrs as srkx,rficd in CCR. Title 23 Divicton 3. Chapter 18, Secuon 2407: 500.000 dollars per occurrence I million dollars annual aggregate or AND or 1 million dollars per occurrence ® 2 million dollars annual aggregate hereby certifies that it is in crnnphance with the requirernori s Of Calitornia Code ofB• AT &T Corporation Regulations. Title 23. Division 1, Chapter 18, Article a. Section 2807. I N.u- 4 wok ( >,— „ th--) The mechanisms used to demonstrate financial r sponsibility as re uired by Section 2807 are as follows: C. Mechanism Name and Address of Issuer Mechanism Coverage Coverage Corrective Third Party I'ype Number Amount Period Action Compensation 1,000,000 Old Republic Insurance per Certificate of Company occurrence 6/1/2010 - MWZZ50517 and Yes YesInsurance414W. Pittsburgh St. 6/1/20122,000,000Greenburg, PA 15601 annual a r re gate Note: II you are using the Suuc Fund as any part of your demonstration of linanci:rl responsibility. your execution and suhmissinn of this certification also certifies that you are in com liance and shall remain in com liance. with all conditions loo panicipation in the Fund. 1) 1 —Iiry N— 4m iiy AJ tress See attached list of locations 1'riliir Norte I :utliiy AJbrss I.>,ihiy Nanr I:,. ihry \dares Iarilitti N.;nr ciliiv 41Jr .,. I.; ilnv Nanr Iyihry .b4hrs. F—h,y N:utr rariht AJJro> FAilin N:urc 6,: hn J4cos E. signetur -v rank r hair N— ant rifle ,p "I :m ) Foul ,rt 01—t,r 5/;1/201 1 Elaine Lou - Assistant "Treasurer i.iuh nnc.. K .rary 11— Nanr ,n 0. N. amp 5/31/201 1 Edna Gilchrist S6bmit original to local UST regulatory agency. Keep a copy at each UST facility. UN -Wf) - 113 %ww.unidocs.org Rev. I0/16 /116 NAME: ADDRESS: POLICY NUMBER: ENDORSEMENT: PERIOD OF COVERAGE NAME OF INSURER: ADDRESS OF INSURER: NAME OF INSURED: ADDRESS OF INSURED: CERTIFICATE OF INSURANCE Per the Attached List Per the Attached List MWZZ50517 Not applicable June 1, 2011 —June 1, 2012 Old Republic Insurance Company 445 South Moorland Road Brookfield, WI 53005 AT&T Inc. and Subsidiaries 208 S. Akard Street Room 2731 Dallas, Texas 75202 CERTIFICATION: 1, Old Republic Insurance Company, the Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tank(s): See Schedule of Tanks on policy referenced above, for taking corrective action and compensating third parties for bodily injury and property damage caused by accidental releases in accordance with and subject to the limits of tiability, exclusions, conditions and other terms of the policy arising from operating the underground storage tank(s) identified above. The limits of liability are $1,000,000 each occurrence and $2,000,000 annual aggregate, exclusive of legal defense costs, which are subject to a separate limit under the policy. This coverage is provided under poticy number MWZZ50517. The effective date of said policy is June 1, 2010. 2. The Insurer further certifies the following with respect to the insurance described in Paragraph 1: a. Bankruptcy or insolvency of the insured shall not relieve the Insurer of its obligations under the policy to which this certificate applies. b. The Insurer is tiable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or damaged third party, with a right of reimbursement by the insured for any such payment made by the Insurer. This provision does not appty with respect to that amount of any deductibte for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95 - 280.102. C12567 C: \DOCUME- 1 \JLHART -1\ LOCALS -1 \Temp \notesE1EF34 \- 7604690.doc c. Whenever requested by a Director of an implementing agency, the Insurer agrees to furnish to the Director a signed duplicate original of the poticy and all endorsements. d. Cancellation or any other termination of the insurance by the Insurer, except for non- payment of premium or misrepresentation by the insured, will be effective only upon written notice and only after the expiration of 60 days after a copy of such written notice is received by the insured. Cancellation for non - payment of premium or misrepresentation by the insured witl be effective only upon written notice and only after expiration of a minimum of 10 days after a copy of such written notice is received by the insured. e. The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of the effective date of Cancellation or non•renewat of the policy except where the new or renewed policy has the same retroactive date or a retroactive date earlier than that of the prior policy, and which arise out of any covered occurrence that commenced after the policy retroactive date, if applicable, and prior to such policy renewal or termination date. Claims reported during such extended reporting period are subject to the terms, conditions, limits, including limits of liability, and exclusions of the policy. I hereby certify that the wording of this instrument is identical to the wording in 40 CFR 280.97 b) (2) and that the Insurer is licensed to transact the business of insurance in one or more states. Signature of Authorized Representative of Insurer Jodi Hartmann Senior Account Manager Old Republic Insurance Company 445 South Moorland Road Brookfield, WI 53005 C12567 Location'Code Addressl city CountylAT&T Tank IDI Tank Capacity Material Stored ATT Enti CUPA CAK010 1520 20TH ST BAKERSFIELD Kern CAK010U001 8000 DIESEL FUEL #2 LOW SULFUR AT &T Cor Bakersfield City Fire