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CERTIFICATE OF LIABILITY INSURANCE (1122) DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/23/2023 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 INSURED,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 lieu of such endorsement(s). PRODUCER CONTACT NAME: Aon Risk Services Southwest, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 Houston TX Office (A/C.No.Ext): A/C.No.): 5555 San Felipe E-MAIL 0 Suite 1500 ADDRESS: _ Houston TX 77056 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Texas Insurance Company 16543 Trillium Transportation Fuels, LLC INSURER B: Ironshore Specialty Insurance Company 25445 PO Box 26210 Oklahoma City OK 73126 USA INSURER C: ACE American Insurance Company 22667 INSURER D: Indemnity Insurance Co of North America 43575 INSURERE: ACE Fire Underwriters Insurance Co. 20702 INSURER F: COVERAGES CERTIFICATE NUMBER:570098462405 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 LTR TYPE OF INSURANCE INSD WVD I POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS C X COMMERCIAL GENERAL LIABILITY Y Y XSLG EACH OCCURRENCE $1,000,000 CLAIMS-MADE -OCCUR SIR applies per policy terns & condi ions $1,000,000 PREMISES Ea occurrence MED EXP(Any one person) PERSONAL&ADV INJURY $1,000,000 p GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $8,000,000 61 X POLICY PEO ❑LOC PRODUCTS-COMP/OP AGG $8,000,000 oo 0 OTHER: o C Y Y ISA H10764610 04/01/2023 04/01/2024 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $5,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) 0 AUTOS ONLY AUTOS R HI RED AUTOS NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident A X UMBRELLALIAB X OCCUR TCOK20347a 12/01/2020 04/01/2024 EACH OCCURRENCE $10,000,000 V EXCESS LIAB CLAIMS-MADE SIR applies per policy terns & conditions AGGREGATE $15,000,000 DED I X RETENTION D WORKERS COMPENSATION AND Y WLRC50734535 04/01/2023 04/01/2024X PER STATUTE OTH- C EMPLOYERS'LIABILITY Y/N Y WLRC50734584 04/01/2023 04/01/2024 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 E OFFICER/MEMBER EXCLUDED, N N/A Y SCFC50734663 04/01/2023 04/01/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000-_ B Environmental Site Liability ISPILLSCHIOA001 04/01/2022 04/01/2025 Aggregate $10,000,000 Each Incident $10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) t- rP MCS90 and CA9948 are included on the above referenced Automobile Liability policy. If required by contract, Certificate Holder �= is Included as Additional Insured in accordance with the policy provisions of the Automobile Liability and General Liability policies. If required by contract, a Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the 36-;policy provisions of the Workers' Compensation, Automobile Liability and General Liability policies. 9. L CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Clearwater AUTHORIZED REPRESENTATIVE Clearwater Gas Z 400 N. Myrtle Ave. c9a ` Clearwater FL 33755 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD