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Home My WebLink About2023 BAKER ST (2) III�III��III IIII 07 IE %Golden Eagle Insurance. 'ENDORSEMENT I mb—f 1Lem w.w C—p Policy Number:CBP9591669 Prior Policy: 9591669 Billing Type: DIRECT BILL Coverage Is Provided In PEERLESS INSURANCE COMPANY-A STOCK COMPANY Named Insured and Mailing Address: Agent: LEE JUNG CHO(PARTNER) NSE INSURANCE AGENCIES LEE SUNG S(PARTNER) 160 S D STREET 2023 BAKER EXETER CA 93221 BAKERSFIELD CA 93305 Agent Code: 4295880 Agent Phone:(559)-592-9411 POLICY CHANGE ENDORSEMENT POLICY PERIOD:From: 05116!2010 To: 0511612011 at 12:01 AM Standard Time at your mailing address shown above. DESCRIPTION OF CHANGE CHANGE EFFECTIVE DATE: 051162010 POLICY PREMIUM HAS BEEN RERATED PER REVISED 17-57 (06!94)ATTACHED. Original Annual Premium $ 6, 821 . 00 New Annualized Premium $ 5, 813. 00 TOTAL RETURN PREMIUM $ 1 , 008. 00 �i Countersigned: By. J • n-0�-� �" �— l o Authorised Reptesertathre Date Date Issued: 07112/2010 17-60(10194) INSURED COPY 051182010 9591669 NN189974 1307 PODNt060D J12427 GCAFPPN 00017687 Pane 5 Z-d b89t7£Z£699 _ sjonbl-I elseig dtig:£006 9L 300 11111111FIR 08 I Golden Eagle %NDORSI=MENT Insurance. NMb4 oflhrry MM%WC P EFFECTIVE DATE: 0511612010 Policy Number: CBP 9591669 Prior Policy: 9591669 Billing Type: DIRECT BILL Coverage Is Provided In PEERLESS INSURANCE COMPANY-A STOCK COMPANY Named Insured and Mailing Address: Agent: LEE JUNG CHO (PARTNER) NSE INSURANCE AGENCIES LEE SUNG S(PARTNER) 160 S D STREET 2023 BAKER EXETER CA 93221 BAKERSFIELD CA 93305 Agent Code: 42956130 Agent Phone: (559)-592-9411 " PEERLESS INSURANCE COMPANY-A STOCK COMPANY P.O. Box 85826 San Diego,CA 92186-5826 COMMON POLICY DECLARATIONS In return for the payment of premium, and subject to all the terms of this policy,we agree with you to provide the Insurance as stated In this policy. POLICY PERIOD: From : 05116/2010 To: 0511 620 1 1 at 12:01 AM Standard Time at your mailing address shown above. FORM OF BUSINESS: PARTNERSHIP BUSINESS DESCRIPTION: MINI-MART/LIQUOR STORE WITH GAS PUMPS This policy consists of the following coverage parts for which a premium is indicated.This premium may be subject to adjustment. PREMIUM Commercial Property Coverage!Part $ 2, 099. 00 Boiler and Machinery Coverage Part INCLUDED Commercial General Liabllity Crnferage Part INCLUDED Liquor Liability Coverage Part INCLUDED Total Premium for all Liablllty Coverage Parts $ 3, 370. 00 Commercial Auto Coverage Part $ 226. 00 Total Policy Premium $ 5, 813 . 00 FORMS AND ENDORSEMENTS Forms and Endorsements made a part of this policy at time of issue: Applicable Forms and Endorsements are ona t5ed It shown to speoifIo Coverage PartiCoverage Form Declarations Form Number Description IL0935 -0702 EXCLUSION OF CERTAIN COMPUTER RELATED LOSSES 17-57(06194) INSURED COPY 05f16=10 9591669 NN189974 1307 PGDM0600 J12427 GCAFPPN nnm7RAQ Pees 7 £'d V99t£Z£L99 sionbil e}sel-� dyg:£OOL SL 100 Golden Eagle ENDORSEMENT InSuyranee. Me�Mral,l�-rry MsY drwp Farming a part of Policy Number: COP 9591669 Coverage Is Provided In PEERLESS INSURANCE COMPANY-A STOCK COMPANY Named Insured: Agent: LEE JUNG CHO (PARTNER) NSE INSURANCE AGENCIES LEE SUNG S(PARTNER) Agent Code: 4295880 Agent Phone: (559)-592-9411 COMMERCIAL PROPERTY COVERAGE PART DECLARATIONS DESCRIPTION OF PREMISES Prem. Bldg. Location No. No. Occupancy, Construction/Fire Protection 1 1 2023 BAKER BAKERSFIELD CA 93305 BEV STORE-LIQUOR A WINE FRAME COVERAGES PROVIDED: Insurance at the described promises applies only for coverages for which a limit of insurance is shown or for which an entry is made.(The Coinsurance column reflects Coinsurance%.Extra Expense%,Limits on Loss Payment or Value Reporting Symbol.) Prom. Bldg. Limit of Causes of No. No. Coverage Insurance Loss Form Coinsurance 1 1 BUILDING $ 202, 000 SPECIAL 90% 1 1 YOUR BUSINESS PERSONAL PROPERTY $ 228, 000 SPECIAL 90% 1 1 BUSINESS INCOME AND EXTRA EXPENSE ALS SPECIAL W A OTHER THAN"RENTAL VALUE" OPTIONAL COVERAGES: Prem. Bldg. Agreed Value Amount Replacement Inflation No. No. Coverage Expiration Date Cost Guard 1 1 BUILDING INCLUDED 1 1 YOUR BUSINESS PERSONAL PROPERTY INCLUDED " Replacement cost For Your Business Personal Property also applies to Stock it an asterisk(')Is present, DEDUCTIBLE: $ 2, 500 MORTGAGE HOLDERS: REFER TO ADDITIONAL INTERESTS SCHEDULE 21-7(07103) INSURED COPY 0.5118!2010 95916% NN189974 1307 PGDM080D J12477 GCAFPPN C=7881 Pepe 9 t7'd V29b£Z£699 sionbl-I elsel_,I dtg:£006 8L lc0 Golden Eagle ;?NDORSEMENT 10�lnsurance. • 61mDn dMbmy 4M AG.., Forming a part of Policy Number: CBP 8591659 Coverage Is Provided In PEERLESS INSURANCE COMPANY-A STOCK COMPANY Named insured: Agent: LEE JUNG CHO(PARTNER) NSE INSURANCE AGENCIES LEE SUNG S(PARTNER) Agent Code: 4295880 Agent Phone: (559)-592-9411 TOTAL ADVANCE PRENHUM FOR ALL LIABILITY COVERAGE PARTS $ 3, 370. 00 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS LIMITS OF INSURANCE Each Occurrence L'ardt $ 1 , 000, 000 Damage To Premises Rented To You Limit $ 100, 000 Any One Premises Medical Expense Limit $ 5, 000 Any One Person Personal and Advertising Injury Limit $ 1 , 000, 000 Any One Person or Organization General Aggregate Limit(Other Than Producte/Completed Operations) $ 2, 000, 000 Products/Completed Operations Aggregate Limit $ 2, 000, 000 LOCATION OF PREMISES Location Number Address of All Premises You Own,Rent or Occupy 001 2023 BAKER BAKERSFIELD CA 93305 PREMIUM Class Classification Description Code Rates Advance Premium Premium Territory Prods/ All Prods/ All Base Code Comp Ops Other Comp Ops Other CA LOCATION 00i 22-19(12/02) INSURED COPY 0616=10 989iem NNlBW74 1307 PGOM0601) J12427 GCAFPPN 000176x3 Pace 1+ 9'd b89vEZ£L99 sionbil elsei_� d99:£0 OL 8L lo0 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS jcolrtlnued) PREMIUM Class Cla5u fica6on DescriplIon Code Rates Advance Premium Premium Territory Prods/ All Prods/ All Base Code Comp Ops Other Comp Ops Other COWL LIABILITY GOLD $ 963 10145 BEVERAGE STORES-LIQUOR AND WINE 1 , 533,026 005 $ 0. 264 $ 1 . 136 $ 405 $ 1 , 742 GROSS SALES PER 41000 13454 GASOLINE STATIONS-SELF SERVICE 375, 000 005 $ 0. 044 $ 2. 191 $ 17 $ 822 GALLONS PER 1000 Ault Period: ANNUAL Tout Advance Premium INCLUDED FORMS AND ENDORSEMENTS Forms and Endorsements applying to this Coverage Part and made part of this policy: Form Number Descr4 tion ILD270 -1104 CANCELLATION AND NONRENEWAL ILD017 -1198 COMMON POLICY CONDITIONS GECG635 -1208 AMENDMENT OF COVERAGE B GECG602 -0904 COMMERCIAL GENERAL,LIABILITY GOLD ENDORSEMENT CG3234 -0105 CALIFORNIA CHANGES CG2426 -0704 AMENDMENT OF INSURED CONTRACT DEFINITION CG2167 -0402 FUNGI OR BACTERIAL EXCLUSION CG2165 -0999 TOTAL POLLUTION EXCL-W/BLDG AND HOSTILE FIRE EXCEPT CG2447 -0798 EMPLOYMENT RELATED PRACTICES EXCLUSION 0GO067 -0305 EXCLUSION-VIOLATION OF STATUTES CGO052 -1202 WAR LIABILITY EXCLUSION CG0001 -1001 COMMERCIAL GENERAL LIABILI'T'Y COVERAGE FORM 22-91 -0204 EXCLUSION-TOBACCO 22490CA -0105 EXCLUSION-SILICA 17-98 -1202 EXCLUSION-ASBESTOS 22-19(12!02) INSURED COPY 05r1G2010 9691869 NN189974 13D7 AGDND60D J124V GCAFPPN 00017694 Page 12 9'd b89b£Z£L99 sionbi-I eisei_� dSS:£O 0 l 8I loo INDORSEMENT Forming a part of Policy Number: CBP 9591669 Coverage Is Provided In PEERLESS INSURANCE COMPANY-A STOCK COMPANY Named Insured: Agent: LEE JUNG CHO(PARTNER) NSE INSURANCE AGENCIES LEE SUNG S(PARTNER) Agent Code: 4295880 Agent Phone: (0-592-9411 COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS(continued) FORMS AND ENDORSEMENTS Forms and Endorsements applying to this Coverage Part and made part of this policy: Form Number Description 17-22 -1202 EXCLUSION-LEAD Includes copyrighted nidarial of Ins mm SeMoes Office,Inc.with As perrnisshm.Copyright,Insurance Services Office,Inc.1962,1983,1984,1985,2000. Date Issued: 07/120010 22-19 (12102) INSURED COPY 05/1612010 9591669 NMIMW4 1307 PGDMO600 J12427 GCAFPPN 00017685 Page 13 L'd b99ti£Z£L99 sionbi-I elsel_� dgg:£OOL9Llo0 BAKERSFIELD FIRE DEPARTMENT UNDERGROUND STORAGE TANKS Prevention Services X4-- g S%Fr-zp a(o( t-t s-MeF-7 APPLICATION lgt Bakerstield, CA 93301 *AF. M fg phone: 661-326-3979 • Fax: 661-852-2171 TO PERFORM ELD/LINE TESTING/ SB989 SECONDARY CONTAINMENT Page 1 of 1 TESTING/TANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION (Please note that these are separate Individual tests and will be charged per separate type test accordingly.) . PERMIT# ❑ ENHANCED LEAK DETECTION 011M TESTING ❑ SB-989 SECONDARY CONTAINMENT ❑ TANK TIGHTNESS EL MONITORING CERTIFICATION FACILITY L NAME&PHONE#OF CONTACT PERSON �.q Una ADDRESS OWNER NAME OPERATOR NAME PERMIT TO OPERATE# #OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? ❑ YES ❑ NO TANK aC VOLUME r CONTENTS TANK TESTING COFIPANY TESTING COMPANY NAME&PHONE#OF CONTACT PERSON — MAILING ADDRESS �Jtn�-l3 ��ook.S CrT. - P.�AcK�RSF(Et-O �C� °13308 NAME A PHONE#OF TESTER OR SPECIAL INSPECTOR CERTIFICATION# v 7 a - 8(o 9 `809 SSv DATE&TIM TEST BE CO DUCTED ICc# TEST METHOD 0 zS t0 ai 00 �aCet oL�3 - OT lmCONJ APPLICANT SIGNATU DATE THI _�*XCATION BECOMES A PERMIT HE APPROVED APPROVED BY DATE FD2095 (Rev 03/08) ,e. EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures.unless required to obtain approval before making the change. Required by Sections 2632(d)and 2641(h)CCR R Facility Name e S--6 Facility Address 2023 P ST 1. If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary containment within S hours, or deteriorate the secondary containmen then the Office of Environmental Services must be notified within 24 houus. ArAf 110A a 2. Describe the proposed methods and equipment to,be used for removing and roperly disposing of any hazardous substance. C r 3. Descri a the location and availability of the required cleanup equipment in item 2 above. he-ki Mnl 0&1 lkkCr 1A .:5461►; 4. Describe the maintenance schedule for the cleanup equipment: de del f0a I 5. List the name(s)and title(s)of the person(s)responsible for authorizing any work necessary under the response plan: WRWEN MONITORING PROSDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This twWwring program mm be Inept at the UST locavoa at au tuna. The uftmatm on this noeitoring program are COMMons of the op=b ng permit. The permit holder mot notify the Office of Enviroomea d Sevicm within 30 days of any changes to the monitoring procedures,unless required to obtain approval befae making the change. Required by Sections 2632(d)and 2641(h)CCR Facility Name _e Facility Address A. Describe the frequency of performing the monitoring: Tank &r v Pining Q, w B. What methods and equipment,identified by name and model, will be used for pafoming the monitoring: Tank Q,( run A T6 Piping lk C. Describe the location(s)where the monitoring will be performed(facility plot plan should be attached): ..0 Y1 0�•�IPr D. List the name(s)and tide(s)of the people responsible for performing the monitoring and/or maintaining the equipment: "J V/,) of o LGr- sunlEr S 60-w E. Reporting Format for monitoring: Tank Piping F. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not ym than every 12 months. &c a p;r, yea r err 1l� A,,al riael< G. Describe the training necessary for the operation of UST system, including piping,and the monitoring equipment: .Me r- 64 4 �-k. ',Ob rrne� ��, 3�A Oct 18 10 03:53p Fiesta Liquors 6613234684 P.1 �'! Dl