HomeMy WebLinkAbout3225 BUCK OWENS BLVD_UST 5.25.10IE
INSPECTIONS
BUSINESS PLAN &
INVENTORY PROGRAM
UNIFIED PROGRAM INSPECTION CHECKLIST
FACILITY NAME-
rAR
Section 2: Underground Storage Tanks Program
❑ Routine ❑ Combined
Type of Tank _
Type of Monitoring _
BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326 -3979
Fax: (661) 852 -2171
Page 1 of 1
INSPECTION DATE:
❑ Joint Agency ❑ Multi- Agency ❑ Complaint ❑ Re- Inspection
Number of Tanks
Type of Piping
OPERATION
C
V
COMMENTS
Proper tank data on file
Proper owner / operator data on file
Permit fees current
Certification of Financial Responsibility
Monitoring record adequate and current
Maintenance records adequate and current
Failure to correct prior UST violations
Has there been an unauthorized release? ❑ Yes ❑ No
SPction_3: Aboveground Storage Tanks Program
Tank Size(s)� Aggregate Capacity
Type of Tank % Number of Tanks
2-5 <Z)
OPERATION
Y
N
COMMENTS
SPCC available
SPCC on file with OES
Adequate secondary protection
Proper tank placarding /labeling
Is tank used to dispense MVF ?)
If yes, does tank have overfill I overspill protection?
C = Compliance V = Violation Y = Yes N = No
Inspector:
Questions regarding this inspection? Please call us at (661) 326 -3979
White — Prevention Services
Business Site Responsible Party
Pink - Business Copy
KBF -7335 FD 2156 (Rev. 09/05)
SoQura. AvENuE, Sui'1'u 202
�►. CRuz, CALiFQRNu 95062,
831.475,8:141.
831.475.8249
FAX TRANSMISSION
May 24, 201.0
Jnspector
)Bakersfield City Fire Dcpt
Fax: 661-952-2171
Re: Testin.g at Valero 3074
3225 Buck Owens Blvd
Bakersfield CA 93301
Dear Inspector:
Triton Construction will be performing Spi.11bux testing at the above site starting
Tuesday, June 1st at 3 PM. Triton Construction is licensed to perform this testing and is
currently listed in your database with regards to licensing and required insurance. Our
testing protocol is available for your review and will be on site during the testing. The
testing results will be submitted to your agency on appropriate forms_
Please contact me at 831.227.4730 if you have any questions.
Sincerely,
Frank Bohnet
17149782615 Tait Envrionmental Servi 12:32:25 p.m. 05 -24 -2010 1 !1
TAI T
OISING TO TNL CN�FC [NGF
p:714156018222 wwwAoil.com
Fax Cover Sheet
TO: Howard Wines FROM: Matt Denison
2131 S. Dupont Drive, Anaheim, CA 92806
COMPANY: Bakersfield Fire Department PHONE: 714- 560 - 8200x404 FAX: 714 - 978 -2615
FAX: (661) 852 -2171 DATE: 5/24/2010
RE: AT &T AST Monitor Certification and, if installed, Spill Bucket Test
Notification
GEO: SA224
Total Number of Pages: 1
Hello. Tait will be at the following location on the date and time indicated to conduct the
Annual AST Monitor Certification and, if installed, Spill Bucket Test.
We are requesting that the Annual Inspection also be performed at this time.
Thank you.
CA Lie #588098 • AZ Lie #095984 • NV Lie #0049666
2131 South Dupont Drive • Anaheim, California 92806 • 714.550.8222 • 714.685.0006 Fax
11280 Trade Center Drive • Rancho Cordova, California 95742 • 916.858.1090 • 916.858.1011 Fax
www.talt.com
11609
SA224
ROSEDALE
BAKERSFIELD
93312
11:30
HWY
7/6/2010
AM
We are requesting that the Annual Inspection also be performed at this time.
Thank you.
CA Lie #588098 • AZ Lie #095984 • NV Lie #0049666
2131 South Dupont Drive • Anaheim, California 92806 • 714.550.8222 • 714.685.0006 Fax
11280 Trade Center Drive • Rancho Cordova, California 95742 • 916.858.1090 • 916.858.1011 Fax
www.talt.com
17149782615 Tait Envrionmental Servi 12:32:09 p.m. 05 -24 -2010 1 /1
TAI T
RISING TO THE CHALLLNrE 2131 5, Duponi Drive. Anaheim, CA 92806
P:714156018222 — w.rolixom
Fax Cover Sheet
TO: Howard Wines FROM: Matt Denison
COMPANY: Bakersfield Fire Department PHONE: 714- 560 - 8200x404 FAX: 714 - 978 -2615
FAX: (661) 852 -2171 DATE: 5/24/2010
RE: AT &T AST Monitor Certification and, if installed, Spill Bucket Test
Notification
GEO: SA006
Total Number of Pages: 1
Hello. Tait will be at the following location on the date and time indicated to conduct the
Annual AST Monitor Certification and, if installed, Spill Bucket Test.
SA006
148 WEEDPATCH
I BAKEISF1EID
93307
HWY
7/6/2010
9:00 AM
We are requesting that the Annual Inspection also be performed at this time.
Thank you.
CA Lic 9588098 • AZ Lic #095984 - NV Lic #0049666
2131 South Dupont Drive - Anaheim, California 92806 - 714.560.8222 - 714.685.0006 Fax
11280 Trade Center Drive - Rancho Cordova, California 95742 • 916.858.1090 - 916.858.1011 Fax
www.taft.com
17149782615 Tait Envrionmental Servi 12:31:48 p.m. 05 -24 -2010 1 /1
TAI T
IIfINO 10 TMI CN •llfNG1
p:714156018222 — .1oit.com
Fax Cover Sheet
2131 S. Duponr Drive. Anoheim, CA 92806
TO: Howard Wines FROM: Matt Denison
COMPANY: Bakersfield Fire Department PHONE: 714 -560- 8200x404 FAX: 714 - 978 -2615
FAX: (661) 852 -2171 DATE: 5/24/2010
RE: AT &T AST Monitor Certification and, if Installed, Spill Bucket Test
Notification
GEO: SA532
Total Number of Pages: 1
Hello. Tait will be at the following location on the date and time indicated to conduct the
Annual AST Monitor Certification and, if installed, Spill Bucket Test.
SA532
11101 WHITE
BAKERSFIELD
I
93307
1
1
LANE
7/12/2010
9:00 AM
We are requesting that the Annual Inspection also be performed at this time.
Thank you.
CA Lic #588098 • AZ Lic #095984 • NV Lic #0049666
2131 South Dupont Drive • Anaheim, California 92806 • 714.560.8222 • 714.685.0006 Fax
11280 Trade Center Drive • Rancho Cordova, California 95742 • 916.858.1090 • 916.858.1011 Fax
www.tait.com
L
at &t
I
May 17, 2010
Bakersfield Fire Department
UST Compliance Department
1501 Truxtun Ave
Bakersfield CA 93301
AT &T EH &S T: 214.464.3131
T 308 S. Akard Street #1700 F: 214.464.1424
Dallas, TX 75202 www.ehs.att.com
RE: Certification of Financial responsibility - Underground Storage Tanks
To whom it may concern,
Enclosed please find a copy of our annual State of California Certification of
financial responsibility and a Certificate of insurance to demonstrate the
financial responsibility of Pacific Bell Telephone Company /dba AT &T California,
AT &T Corp and /or its affiliate company for its underground storage tanks.
Also enclosed please find a list of the sites that are covered by insurance and
that have underground storage tanks on the premises in your area of
jurisdiction.
If you have any questions or require.any additional information, please feel
free to contact me at (214) 464.3131 or by email at shl975 @att.com.
Thank you for your help complying with this "requirement.
Sincerely,
Steven I Hall
Manager, Environment, Health & Safety
AT &T Services Inc.
Attachment: Certification of Financial Responsibility
List of insured sites with underground storage tanks
Certificate of insurance
'C.)C.Y Proud Sponsor of the U.S. Olympic Team ,
t
i
State of California
Fur State Use Only
State of Water Resources Control Board
Division of Financial Assistance
P.O. Box 944212
Sacramento, CA 94244 -2120
(Instructions on reverse side)
CERTIFICATION OF FINANCIAL RESPONSIBILITY
FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM
A. l am required to demonstrate Financial Responsibility in the required amounts as specified in Section 2807', Chapter 18, Div. 3, Title 23, CCR:
500,000 dollars per occurrence I million dollars annual aggregate
or AND or
1 trillion dollars per occurrence �2 million dollars annual aggregate
B. AT&T CORP. hereby certifies that it is in compliance with the requirements of
(Name of Tank Owner or Operator) '
California Code of Regulations, Title 23, Division 3, Chapter 18, Article 3, Section 2807.
The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows ::
C. Mechanism
Mechanism '
Coverage
Coverage
Corrective
Third Party .
Type
Name and Address of Issuer
Number
Amount
Period
Action
Corn
Certificate of Insurance
Old Republic.
MWZZ50517
$1,000,000 per
06/01/2010 -
YES
YES
Insurance Company.
occurrence and
06/01/2012
414 W. Pittsburgh St.
$2,000,000
Greensburg, PA 15601
annual aggregate
Note: if you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission
of this certification also certifies that you are in compliance and shall maintain compliance with all conditions for participation
in the Fund. See instructions.
D. Facility Name
Facility Address
See Attached
Facility Name
Facility Address
Facility Name
Facility Address
E. Signature of Tank Owner or Operator Date
Name and Title of Tank Owner or Operator
/
5 /10 /10
Elaine Lou
Signature of Witne r NotarN Date
Name of Witness or Notary
' 1
. '�--- 5 /10/10
/
Edna Gilchrist
CFR ( Revised 08/06) FILE: Original -Local Agency' Copies - Facility /SiteW
CERTIFICATE OF INSURANCE
NAME: Per the Attached List
ADDRESS: Per the Attached List
POLICY NUMBER:
ENDORSEMENT:
PERIOD OF COVERAGE:
NAME OF INSURER:
ADDRESS OF INSURER:
NAME OF INSURED:
ADDRESS OF INSURED:
MWZZ50517
Not applicable
June 1, 2010 —June 1, 2012
Old Republic 1n.surance Company
445 South Moorland Road
Brookfield, WI 53005
AT &T Inc. and Subsidiaries
208 S. Akard Street
Room 2731 _
Dallas, Texas 75202
0
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):
W
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 liability, 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 policy 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 liable 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 apply with respect to that amount of any deductible for which coverage is
demonstrated under another mechanism or combination of mechanisms as specified in 40
CFR 280.95- 280.102.
c. Whenever requested by a Director of an implementing agency, the Insurer agrees to furnish
to the Director a signed duplicate original of the policy.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 will 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 - renewal 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. 4
Signature of Authorized Representative of Insurer
Sharon W. Abel
Account Management Director
Old Republic Insurance Company
445 South Moorland Road
Brookfield, WI 53005
C12567
2
01
17
May 17, 2010
Bakersfield Fire Department
UST Compliance Department
1501 Truxtun Ave
Bakersfield CA 93301
AT &T EH &S T: 214.464.3131
308 S. Akard Street #1700 F: 214.464.1424
Dallas, TX 75202 www.ehs.att.com
RE: Certification of Financial responsibility - Underground Storage Tanks
To whom it may concern,
Enclosed please find a copy of our annual State of California Certification of
financial responsibility and a Certificate of insurance to demonstrate the
financial responsibility of Pacific Bell Telephone Company /dba AT &T California,
AT &T Corp and /or its affiliate company for its underground storage tanks.
Also enclosed please find a list of the sites that are covered by insurance and
that have underground storage tanks on the premises in your area of
jurisdiction.
If you have any questions or require any additional information, please feel
free to contact me at (214) 464.3131 or by email at shi975 @att.com.
• Y
Thank you for your help complying with this requirement.
Sincerely,
Steven 7 Hall
Manager, Environment, Health & Safety
AT &T Services Inc.
Attachment: Certification of Financial Responsibility
List of insured sites with underground storage tanks
Certificate of insurance
U
'C7CT Proud Sponsor of the U.S. Olympic Team
• State of California
For State Use Only
State of Water Resources Control Board
Division of Financial Assistance
P.O. Box 944212
Sacramento, CA 94244 -2120
(instructions on reverse side)
CERTIFICATION OF FINANCIAL RESPONSIBILITY
FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM
A. I am required to demonstrate Financial Responsibility in the required amounts as specified in Section 2807, Chapter 18, Div. 3, Tide 23, CCR:
F] 500,000 dollars per occurrence I trillion dollars annual aggregate
or AND or
I million dollars per occurrence Fx--12 million dollars annual aggregate
B. Pacific Bel/ Telephone Co. dba AT &T California hereby certifies that it is in compliance with the requirements of
(Name of Tank Owner or Operator) '
California Code of Regulations, Title 23, Division 3, Chapter 18, Article 3, Section 2807.
The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows:
C. Mechanism
Mechanism
Coverage
Coverage
'Corrective
Third Party
Type
Name and Address of Issuer
Number
Amount.
Period
Action
Comp
ertificate of Insurance
Old Republic
MWZZ50517
$1,000,000 per
06 /01/2010 -
YES
YES
Insurance Company
occurrence and
06/01/2012
414 W. Pittsburgh St.
$2,000,000
Greensburg, PA 15601
annual aggregate
Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission
of this certification also certifies that you are in, compliance and shall maintain compliance with all conditions for participation
in the Fund. See instructions.
D. Facility Name
Facility Address
See Attached
Facility Name
Facility Address
Facility Name
Facility Address
E. Signature of Tank Own perator Date
Name and Title of Tank Owner or Operator
- -— 5 /10/10
Daniel V. James — Assistant Treasurer
Signature of Witiyss or tary Date
Name of Witness or Notary
-- 5 /10/10
Edna Gilchrist
YV--- (---
CFR (Revised 08/06) 1 FILE: Original - Local Agency Copies - Facility /Site.(s)
1
CERTIFICATE OF INSURANCE
NAME: Per the Attached List
ADDRESS: Per the Attached List
POLICY NUMBER: MWZZ50517
ENDORSEMENT: Not applicable
PERIOD OF COVERAGE: June 1, 2010 —June 1, 2012
NAME OF INSURER: Old Republic Insurance Company
ADDRESS OF INSURER: 445 South Moorland Road
Brookfield, WI 53005
NAME OF INSURED: AT &T Inc. and Subsidiaries
ADDRESS OF INSURED: 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 liability, 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 policy 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 liable 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 apply with respect to that amount of any deductible for which coverage is
demonstrated under another mechanism or combination of mechanisms as specified in 40
CFR 280.95- 280.102.
.
c. Whenever requested by a Director of an implementing agency, the Insurer agrees to furnish
to the Director a signed duplicate original of the policy 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 will 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 - renewal 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
Sharon W. Abel
Account Management Director
Old Republic Insurance Company
445 South Moorland Road
Brookfield, WI 53005
C12567 2
AT&T Confidential
Pacific Bell CUPAs (2)
5/10/2010
s
ESM
AT ARMSTRONG '
AT ARMSTRONG
Page 5
' at &t
May 17, 2010
Bakersfield Fire ,Department
UST Compliance Department
1501 Truxtun Ave
Bakersfield CA 93301
AT &T EH &S T: 214.464.3131
'308 S. Akard Street #1700 ' F: 214.464.1424
Dallas, TX 75202 www.ehs.att.com
RE: Certification of Financial responsibility - Underground Storage Tanks
To whom it may concern,
Enclosed please find a copy of our annual State of California Certification of
financial responsibility and a Certificate of insurance to demonstrate the
financial responsibility of Pacific Bell Telephone Company /dba AT &T California,
AT &T Corp and /or its affiliate company for its underground storage tanks.
Also enclosed please find a list of the sites that are covered by insurance and
that have underground storage tanks on the premises in your area of .
jurisdiction.
If you have any questions or require any additional information, please feel
free to contact me at (214) 464.3131 or by email at sh1975Calatt.com.:
s
Thank you for your help complying with this requirement.
Sincerely,
Steven I Hall '
Manager, Environment, Health & Safety
AT &T Services Inc.
Attachment: Certification of Financial Responsibility
List of insured sites with underground storage tanks .
Certificate of insurance
Proud Sponsor of the U.S. Olympic Team
State of California
For State Use Only
State of Water Resources Control Board
1 Division of Financial Assistance
-� P.O. Box 944212
Sacramento, CA 94244 -2120
(Instructions on reverse side)
CERTIFICATION OF FINANCIAL RESPONSIBILITY
FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM
A. I am required to demonstrate Financial Responsibility in the required amounts as specified in Section 2807, Chapter 18, Div. 3. Title 23, CCW .
F1500,000 dollars per occurrence F] I million dollars annual aggregate
or AND or
1 million dollars per occurrence a 2 million dollars annual aggregate .
B. Pacific Bel/ Telephone Co. dba AT&T California hereby certifies that it is in compliance with the. requirements of
(Name 'of Tank Owner or Operator)
California Code of Regulations, Title 23, Division 3, Chapter 18, Article 3, Section 2807
The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows:
C. Mechanism
Mechanism
Coverage
Coverage
Corrective
Third Party
Type
Name and Address of Issuer
Number
Amount
Period
Action
Comp
Certificate of Insurance
Old Republic
MWZZ50517
$1,000,000 per
06/01/2010 -
YES
YES
Insurance Company
occurrence and
06/01/2012
414 W. Pittsburgh St.
$2,000,000
Greensburg, PA 15601
annual aggregate
Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission
of this certification also certifies that you are in compliance and shall maintain compliance with all conditions for participation
in the Fund. See instructions.
D. Facility Name .
Facility Address
See Attached
Facility Name
Facility Address
Facility Name
Facility Address
E. Signature of Tank Own perator Date
Name and Title of Tank Owner or Operator
-- ---�— 5./10/10
Daniel V. James — Assistant Treasurer
Signature of Wi ss ar tary Date
Name of Witness or Notary
/10/10
Edna Gilchrist
CFR ( Revised 08/06) FILE: Original -Local Agency Copies . Facility /Site(s)
CERTIFICATE OF INSURANCE
NAME: Per the Attached List
ADDRESS:,-,- Per the Attached List
POLICY NUMBER: MWZZ50517
ENDORSEMENT: Not applicable
PERIOD OF COVERAGE: June 1, 2010 —June 1, 2012
",NAME-OF INSURER: Old Republic Insurance Company
ADDRESS OF INSURER: 445 South Moorland Road
Brookfield, W(53005 :
NAME OF INSURED: AT &T Inc. and Subsidiaries
ADDRESS OF INSURED:, 208 S. Akard Street
Room 2731
Dallas, Texas 75202
CERTIFICATION:
1: Old Republic-Insurance Company, the Insurer, as identified above; hereby certifies 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 liability, exclusions,
conditions and other terms of the policy arising from operating the underground storatge.tank(s)
identified above.
The limits of liability are $1,000,000 each occurrence and $2,000,000'annuat aggregate;: exclusive of
legal defense costs; which are subject to a separate limit under the policy: This coverage is provided
under policy 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 liable 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 apply with respect to that amount of any deductible for which coverage is
demonstrated under another'mechanism or combination'of mechanisms asspecified in 40
CFR 280.95- 280.102.
1
c. Whenever requested-by a Director of an implementing agency, the Insurer agrees to furnish
to the Director a signed duplicate original of the policy 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 will 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 - renewal 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 `
Sharon W. Abel
Account Management Director
Old Republic Insurance Company
445 South Moorland Road
Brookfield, WI 53005
p
C12567 2
r�
r�
AT&T ConfidenUal
Pacific Bell CUPAs (2)
wz-1- r. Er I —,1_ 1 --1-2
5(1012010
41ar4
AUFORNIA 1BAKERSFIELD FIRE DEPARTMENT
ALIFORNIA BAKERSFIELD FIRE DEPARTMENT
;RANT ARMSTRONG
;RANT ARMSTRONC.a "
Page 5