CERTIFICATE OF LIABILITY INSURANCE (1090).a►�R�® CERTIFICATE OF LIABILITY INSURANCE
DATE'M&2O2;YYYj
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL ENSURE , the policy(ies) must have ADDITIONAL INSURED provisions or 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 Iieu of such endorserruant(s).
PRODUCER
Aon Risk services southwest, Inc.
Houston TX Office
5555 San Felipe
suite 1500
CONTACT
NAME:
(AIC. No. Ext): (866) 283-7122 AC No.,:(800) 363-0105
E-MAIL
ADDRESS:
Houston Tx 77056 USA
XSLG71570307
SIR applies per policy terns
& conditions
IMSURER(S) AFFORDING COVERAGE MAIC #
INSURED
INSURER A: Ironshore specialty Insurance Company 25445
Trillium Transportation Fuels, LLC
PO Bax 26210
INSURER B: ACE American insurance Company 22667
INSURER C: Texas insurance Company 16543
Oklahoma City Du 73126 USA
INSURERD: westchester Fire Insurance company 10030
INSURERE: Indemnity insurance CO Of North America 43575
INSURER F: ACE Fire underwriters insurance Co. 20702
COVERAGES L:ERi IFiGATE NUMBEH: blUU9U201848 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
tNSR
LTR
TYPE OF INSURANCE
Icy
WVp
POLICY NUMBER
vULICY EFF
pplYYY
MMIDDIYYYY
LIMITS
ts
H COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 771 OCCUR
y
Y
XSLG71570307
SIR applies per policy terns
& conditions
Z77717=
EACH OCCURRENCE $1, 000 , 000
$1,000,000
PREMISES Ea occurrence
N1ED EXP (Any one person)
PERSONAL&ADV INdURY $1,000,000
GE N'L AGGR EGATE LIMIT APP LIES PER:
POLICY LJJECT 1-1CTSLOC
$8,000,000
LENERALAGGREGATE
DU-COMPIOPAGG $8,000,000
OTHER:
B
AUTOMOBILE LIABILITY
Y
Y
ISA H25313719
12/01/202004/01/2022
COMBINED SINGLE LIMIT $5,000.000
Eaa n
BODILY INJURY ( Per person)
X ANYAUTO
OWNED SCHEDULED
AUTOS ONLYAUTOS
HIREDAUTOS NON -OWNED
ONLY AUTOS ONLY
BODILY INJURY (Per aaident)
PROAERTYDAMAGE
Per accklenl
C'
X UMSRELLALIAB
TCOK 47a
12/01/202
12/01/2023
EACH OCCURRENCE S10,000,000
EXCESS LIAB
TOrCUFA
S4AAOE
SIR applies per policy terns
& conditions
AGGREGATE $15, 000, 000
DED X RETENTION
E
B
F
WORKERS COMPENSATIONAND
EMPLOYE RT LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE
bFFICER�WEMBER EXCLUDED?
N MIA
Y
Y
y
WLRC 701
WI-RC68926749
SCFC68926786
12/01 20 217761-1
12/01/2021
12/01/2021
20 2
04/01/2022
04/41/2022
X PER STATUTETK.
E.L-EACH ACCIDENT $1,000,000
E.L- DISEASE -EA EMPLOYEE $1, 000 , 000
(Mandalory in NHJ
It yes, descrlbe under
DESCRIPTION OF OPERATIONS below
E.L- DISEASE -POLICY LIMIT $1, 000 , 000
A
Env site Liab
002568601
12/01/2018
04/01/2022
Aggregate $10P000,000
Each Incident $10,000,000
DESCRIPTION OF OPERATIONS! LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
MCS90 and CA9948 are included on the above referenced Automobile Liability polity. Clearwater Gas System is included as
Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. A
waiver of subrogation is ranted in favor of Certificate Holder in accordance with the policy provisions of the General
Liability, Automobile Liability and workers' compensation policies.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
RECEIVED EXPIRATION DATE THEREOF, NOTICE WILL RE DELIVERED IN ACCORDANCE VATH THE
POLICY PROVISIONS.
Clearwater Gas System AUTHORIZED REPRESENTATIVE
400 N. myrtle Avenue NOV { 2021
Clearwater FL 33755 USA tl I ( �-� 1�J�
&1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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