CERTIFICATE OF LIABILITY INSURANCE (1098) CERTIFICATE LIABILITY CE =yY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT'S 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 INSURED,the Po''licy(Ie's)must have ADDITIONAL INSURED',provision's or be endorsed.if
SUBROGATION I'SWAIVED,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 balder In lieu of such endorsement(s).
PRODUCER CONTACT "7
AOn Risk services southwest, 'Inc, -N
HOUStOn TX Office � .iNe.Exl,l: 48G5.� -;iA,22 �a Na.yl 08009 3fi3-01.D5 pY
5555 San Felipe E-MAIL
Suite 1500ADDRESS: Q
Houston Tx 77056 USA
INSURER(S)AFPORDING COVERAGE MAIC#
INSURED INSURER AI 'texas Insurance 'Company' 16543
Trillium Transportation Fuels LLC INSURER B; ACE American insurance Company 22667
PO Box 26210
Oklahoma City OK 73126 USA INSURER C: zndemnity Insurance 'Oo of North America 4357
INSURERD; ACE Fire Underwriters Insurance Co, 2070.2
INSURER E; Ironshore specialty Insurance company 25145
INSURER F�
COVERAGES CERTIFICATE NUMBER.570092031500, 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,UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
YIEXP
LTR TYPE OF INSURANCE ....IND WVD POLICY NUMBER MMUOOdyYYY MOLIC Y'YYY LIMITSX COMMERCIAL GENERAL LIABILITY Y Y XS:L672489019 EACH OCCURRENCE $1,000,000
rr. 77 SIR applies per policy terns condi ions -. EF1TE
CI'. aS AlMS-MAKE I'O^C'CrII'� $1,000,000PREMISES:Ea occurrence)
�! MED EXP(Any one person) .._.
. PERSONAL.&ADV INJURY $1,000,000
GEIN'LAGGiREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $8,000,000
XPR '', a>
(POLICY II�`� O-T LOC PRODUCTS-COMP/OPAGG S8,000,000 N
I lPR
'OTHER:
n
B' AUTOMOBILE LIABILITY Y' Y ISA H25564315 04/01/2022 04/01/2023 COME I NED SINGLE UMIT
Ea.acsdenti $5,000,000
X ANY AUTO BODILY INJURY I Per parson)
OWNED SCHEDULED SOD IL.Y'INJURY(Peraccidemtp pi
AUTOS
HIRED AUr]TOS NON,OW1NED PROPERTY DAMAGE...
ONLY AUTOS ONLY Per accidenn
A X UMBRELLALIA6 X' OCCUR TSIR
2 a. 12/01/2020 12/01/2023 EAC'HOCCUR RENCE 10,.000,000
EXCESS LIAB CLAIMS-MADE applies per policy ter S c4e Condi 'ionsAGGREGATE $15,000.,000OED )F RETENTIIOiNC WORKERS COMPENSATION AND ..J 4 O4t OI 202 + IPFH BTATEITE. . f•:bTH-...
D C�PFIIGEOPRIEroRCXCIf3DkI7? YNN'NIA Y sCFC68�924728 04/01/2022 04/01/2023 E.L.EACH ACCIDENT ER $I.,000,000
EMPLOYERS"LIABILITY
ANYCERW,MBEr Rr XCLI,)PAIi DED UXFGUF!Iar 924765 04/01./2022 04/01/2023
IMandatory In NH) E.L,DISEASE-EA EMPLOYEE $1,0OG,000
VI yyes,dessaritsa urhr doff
DESCRIPTION Or OPERATIONS haln E.L.DISEASE-POLOCY LIMIT $1,000,000--
E Env Siete LTab 1SP1LLSCHJOA001 04/01/Z022 04/01./2025 Aggregate 10,000,0
Each incident $10,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,maybe attached if more space is required)
Mc590 and CA9948 are -included on the above, referenced Automobile Liabilit polic . Clearwater Gas system is included as
Additional Insured in accordance with the policy provisions Of the Genera 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 Liailit,y and workers" compensation policies. °
CERTIFICATE'HOLDER CANCELLATIONSHOULD ANY THE ABOVE
THE
RECEIVED EXPIRATION DATTE THEREOF,, NOTICECRIBED WILLL BE DEILIVERED CIES INANCELLED ACCORDANCEF
ORE
VAITH THE mm*
POLICY PROVISIONS.
Clearwater Gas System AUTHORIZED REPRESENTATIVE
400 N. Myrtle Avenue
Clearwater FL 33755 USA
C
01988-2415 ACORD CORPORATION..All rights reserved.
ACORD 25(2016143) The ACORD name and logo are registered marks of ACORD