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INSTALL_2024
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR2600076
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INSTALL_2024
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Entry Properties
Last modified
2/23/2026 2:03:26 PM
Creation date
10/29/2024 8:54:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2024
RECORD_ID
PR2600076
PE
2351 - UST FACILITY - 2481 COMPLIANT
FACILITY_ID
FA0005924
FACILITY_NAME
H&M PETROLEUM CORP
STREET_NUMBER
3780
Direction
N
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
Zip
95304
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
Site Address
3780 100 N TRACY BLVD TRACY 95304
Suite #
100
Tags
EHD - Public
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ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> `644� 1 03/07/2024 <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 Shale Pearson <br /> NAME: <br /> TLB Insurance Services PHONE Ext : (916) 790-5863 FAX No): (888) 329-8842 <br /> CA License#0882095 E-MAIL s: shala-pearson@leavitt.com <br /> ADDRE <br /> 2358 Maritime Dr, Ste 100 INSURER(S)AFFORDING COVERAGE NAIC# <br /> Elk Grove CA 95758 INSURERA: Westchester Surplus Lines Insurance Company 10172 <br /> INSURED INSURER B: Travelers Property Casualty Company of America 25674 <br /> Walton Engineering, Inc. INSURER C: Service American Indemnity Company 39152 <br /> P.O. Box 1025 INSURER D: Travelers Property Casualty Company. 36161 <br /> INSURER E: <br /> West Sacramento CA 95691 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 24/25All Lines REVISION NUMBER: <br /> THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAYBE 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 /> INSR AUULISU13K POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> ::/ DAMAGE TO RENTED <br /> CLAIMS-MADE /% OCCUR PREMISES Ea occurrence $ 50,000 <br /> X Inc. Professional Liability MED EXP(Any oneperson) $ 5,000 <br /> A G47393735002 03/06/2024 03/06/2025 PERSONAL&ADV INJURY $ 1,000,000 <br /> GENTAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY PRO- 2,000,000 PRODUCTS-COMP/OP AGG $OTHER: I $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 <br /> Ea accident <br /> X ANYAUTO BODILY INJURY(Per person) $ <br /> B OWNED SCHEDULED 8108L785302 03/06/2024 03/06/2025 BODILY INJURY Per accident $ <br /> AUTOS ONLY AUTOS ( ) <br /> X HIRED �/ NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY /� AUTOS ONLY Per accident <br /> Uninsured motorist $ 1,000,000 <br /> UMBRELLA LIAB •""""""OCCURRENCE <br /> """• <br /> OCCUR EACH OCCC URRENCE $ 10 000,000 <br /> A X EXCESS LIAR 11 CLAIMS-MADE G47393747002 03/06/2024 03/06/2025 AGGREGATE $ 10,000,000 <br /> DED I X1 RETENTION $ 0 $ <br /> WORKERS COMPENSATION /� STATUTE ERH AND EMPLOYERS'LIABILITY Y I N <br /> C OFFICER/ME MB ANYPROPRIMB ER EXCLUDED?R/PARTNER/EXECUTIVE ❑ N/A SAMTWC10020101 10/01/2023 10/01/2024 E.L.EACH ACCIDENT $ 1,000,000 <br /> (Mandatory in NH)If yes,describe under E.L. DISEASE-FA EMPLOYEE $ 1,000,000' <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ 1,000,000 <br /> Pollution Liability <br /> A G47393735001 03/06/2024 03/06/2025 Limit 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <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 /> To Whom it May Concern Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <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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