CERTIFICATE OF LIABILITY INSURANCE (1100) MSC#17755
Aon Risk Services
PO Box 1447
Lincolnshire,IL 60069
MDG2021 00000091 01
Clearwater Gas CNG Site
1020 N. Hercules Avenue
Clearwater FL 33755
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CERTIFICATE F 12J002PROPERTY INSURANCE CE PATE 2/22421021 Y)
/
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.
PRODUCER - CONTACT
NAME:
Aon Risk Services Southwest, Inc. PHONE <866) 283-7122 FAX (800) 363-0105
Houston TX office (A/C.No.Ext):. (AJC,No.):
5555 San Felipe E-MAIL >~
Suite 1500 ADDRESS: _ ca
Houston TX 77056 USA OUSTOMEaID#: 570000058326
INSURER(S)AFFORDING COVERAGE NAIL# n
wi
INSURED INSURER A:. Colony Insurance Company 39993
Trillium Transportation Fuels, LLC INSURER B:
PO Box 26210 INSURER C:
Oklahoma City OK 73126 USA INSl1RERD:'
INSURER E:
L. INSURER F:
_COVERAGES CERTIFICATE NUMBER: 570090475749 REVISION NUMBER:
LOCATION OF PREMISES/DESCRIPTION OF PROPERTY(Attach ACORD 101,Additional Remarks Schedule,it more space is required)
RE: Clearwater Gas CNG Site, 1020 N. Hercules Ave., Clearwater-, FL 33755.
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 �y
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. rn
INSRTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION COVERED PROPERTY LIMITS O�
LTR DATE(MM/DD/YYYY) DATE (MM/DD/YYYY) rn
A X PROPERTY BPR1402750 1210112021 12/01/2022 0
.BUILDING
1�-
CAUSES OF LOSS DEDUCTIBLES PERSONAL PROPERTY an
BASIC BUILDING BUSINESS INCOME
CC
BROAD CONTENTS EXTRA EXPENSE e LU
X SPECIAL RENTAL VALUE
EARTHQUAKE
BLANKETBUILDING z
BLANKET PERS PROP W
WIND f-
FLOOD
X BLANKET BLDG&PP $5,000,000 2
LL
Blkt B&PP Dad X Loss Limit $5,000,000 Dt'-
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C,A
INLAND MARINE TYPE OF POLICY
CAUSES OF LOSS
POLICY NUMBER
NAMED PERILS
CRIME
TYPE OF POLICY
BOILER&MACHINERY/ _
EQUIPMENT BREAKDOWN
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SPECIAL CONDITIONS/OTHER COVERAGES(ACORD 101,Additional Remarks Schedule,may 6e attached if more space is required)
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CERTIFICATE HOLDER CANCELLATION � o
SHOULD ANY OF THE.ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY �
PROVISIONS. rG.e o
Clearwater Gas CNG Site o
1020 N. Hercules Avenue
Clearwater FL 33755 USA AUTHORIZED REPRESENTATIVE {��//J__ /�f�'J o
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Uo 1995-2015 ACORD CORPORATION.All rights reserved.
ACORD 24(2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: 570000058326
LOC#:
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY NAMED INSURED
Aon Risk services southwest, Inc. Trillium Transportation Fuels, LLC
POLICY NUMBER
see certificate Number: 570090475749
CARRIER NAIC CODE
See certificate Number: 570090475749 EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 24 FORM TITLE: Certificate of Property Insurance
carrier Participation
Participation: 50%
Carrier: Colony Insurance Company
Policy Number: BPR1402750
Effective Dates: 12/1/21 to 12/1/22
Participation: 27.5%
carrier: Lloyds 1618 1<1I (36.37%), Aviva insurance Limited (27.27%), Lloyds 2987 (27.27%), Lloyds 2988 (9.09%)
Policy Number: B1230AP1070GA21
Effective Dates: 12/1/21 to 12/1/22
Participation: 22.5%
Carrier: Everest Indemnity Insurance company
Policy Number-, CA3P006779211
Effective Dates: 12/1/21 to 12/1/22
ACORD 101(2008/01) 0 2008 ACORD CORPORATION.All rights reserved.
The ACORD name and logo are registered marks of ACORD