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Home My WebLink AboutRELIANT HOLDINGS LTD - INSURANCE CERTIFICATE 2021-2022O 03-26-2021 2:16 PM Fax r City of Fort Collins pg 1 of 2 CERTIFICATE OF LIABILITY INSURANCE on� �MMioonvvv� sizeizoz� THIS CERl1FICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICATE HOLDER. lHIS CERlIFICATE DOES NOT AFFIRMAl1VELY OR NEGAlIVELY AMEND, EXTEND OR ALlER THE COVERAGE AFFORDED BY THE POLIqES BELOW. THIS CERl1FICAlE OF INSURANCE DOES NOT CONSlIlUTE A CONTRACT BENVEEN THE ISSUING INSURER�S), AUlHORIZED REPRESENTAl1VE OR PRODUCER, AND THE CERl1FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIlIONAL INSURED, the policy�ies) must have ADDIl10NAL INSURED provisions or be endorsed. If SUBROGAlION 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 riahts to the certificate holder in lieu of such endorsementlsl. PROOUCER Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 75102 iNsuREo Reliant Holdings, Ltd. "List of Named Insureds shown below" 10817 West County Road 60 Midland TX 79707 COVERAGES CERTIFICATE NUMBER: 1015534690 REVISION NUMBER: 26620 32620 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. INSR AOOL SUBR POLICY EFF POLICY EXP �� TYPEOFINSURANCE POLICYNUMBER MMIOOIYYYY MMIOOIYYYY LIMITS C j�' COMMERCIALGENERALLIABILITY G71795652002 3/26/2021 6/1/2022 EACHOCCURRENCE st,000,aaa CLAIMS-MADE �OCCUR PREMISES�EaaNcurrence $50,000 Y` BI&P� �ecl d1000 MED EXP (Any ane persan) $ 5,000 y` XCLIno[evduded PERSONAL&ADVINJURV $i,000,aaa GEN'LAGGPEGATEIJMITAPPLIESPEP_ GENEPALAGGPEGATE $2,000,000 POLICV � PR� � LOC PRODUCTS-COMP/OPAGG sz,000,aaa JECT OTHER: $ E AUTOMOBILELIABILITY GAL4840019-00 3/26/2021 6/1/2021 COMBINEDSINGLELIMIT g��000,000 Ee eccident j�' ANVAUTO BODILVINJUPV(Perpersan) $ OWNED SGHEDULED BODILV INJUPV (Pereccidenf) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPERTVDAMAGE $ AUTOS ONLV AUTOS ONLV Per accident Y` MCS-3a $ 6 j( UMBRELLALIAB .� OCCUR 42-UM0347368-03 3/2G/2021 6/1/2022 EACHOCCURRENCE $5,000,000 � P-001-444141412-03 3/2G/2021 6/1/2022 X EXCESSLIAB GLAIMS-MADE AGGREGATE $5,000,000 DED X F2ETENTION$ �s,000,000/Gcs S$5,000,000/A p WORKERSCOMPENSATION WC111026505 3/26/2021 3/26/2022 y� PER �. OTH- A ANOEMPLOYERS'LIABILITY ylN WC185582305 3/26/2021 3/26/2022 STATUTE ER AlternateEm la ANVPROPRIEfOR/PARTNER/EXECUTNE p� NIA ELEACHACQDENT si,000,aaa OFFlCER/MEMBER EXC W DE09 �MantlatoryinNH� ELDISEASE-EAEMPLOVEE $1,000,000 fyes, describe under DESCRIPTIONOFOPERATIONSbelaw ELDISEASE-POLICVLIMIT si,000,aaa c conheaors Palluoon LiebiliCj G71795652 002 3/26/2021 6/1/2022 Each qaim $1,OOQ000 Off-Si[� P�lic9qqgrega[e $1,OOQ000 oea�nmi� gia,000 OESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES �ACORO 101, Atltlitional Remarks Schetlule, may be attachetl if more space is requiretl� Primary Um6rella Policy #42UM030736803 $5,000,000/Occurrenc�$5,000,000/Aggregate and Excess Policy Number #P00100010141203 $S,OOD,ODO/Occurrenc�$S,OOO,�OD/Aggregate for a total of $10,OD0,000 in Excess limits. The General Lia6ility, Automobile Lia6ility and Pollution Liability policies include a 6lanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Lia6ility, Automobile Liability, Um6rella Lia6ility, Excess Liability and Workers' Compensation policy indudes a blanket waiver of subrogation endorsement to the certifcate holder when required by wntten contract. See Attached... SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins PO Box 580 Fort Collins CO 80522 Janna Gonzalez, Certificate CSR ,n� 817-34&2384 FpIC. Nol' S'I7-347-EHS'I iNsuRERo: Axis Surplus Insurance Compan� iNsuRER E: National Interstate Insurance Co. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD O 03-26-2021 2:16 PM Fax r City of Fort Collins pg 2 of 2 AGENCYCUSTOMERID: RELIHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Higginbotham Insurance Agency, Inc. POLICY NUMBER CARRIER ADDIl10NAL REMARKS NAIC COOE NAMEOINSUREO Reliant Holdings, Ltd. "List of Named Insureds shown below" 10E17 West County Road 60 Midland TX 79707 EFFECTIVE OATE: THIS ADDIl10NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM 11TLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 General Liability and Automobile Liability policy has a blanket Primary & Non Contnbutory endorsement that affords that coverage to certifcate holders only �e there is a written contract 6etween the Named Insured and the certifcate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Compensation Policy #WC111026505 Covered States- AL,AR,AZ,CA,CO,GA,IA,KS,MS,NC,NM,TXpK Compensation Policy #W�185582305 Covered States FL,OR Excess liability is underlying the General Liability, Automo6ile Liability and the Employers Lia6ility and follows form on the underlying forthe additional insured. " Supplemental Name " Name Pnnted on DEC Page: Reliant Holdings, Ltd. FL00O2 Management Group, LLC FL00O2, Ltd. Meek Refngeration Inc. RDS Leasing, LLC Reliant Atlantic Group, LLC Reliant Atlantic Group, Ltd Reliant Distri6ution Group, LLC Reliant Distribution, Ltd. Reliant Dry Ice Group, LLC Reliant Dry Ice Pacifiq LLC Reliant Dry Ice, Ltd. Reliant Employment Group, LLC Reliant Employment Services, LTD Reliant Equipment Leasing II, LLC Reliant Equipment Leasing, LLC Reliant Exploration & Production, LLC Reliant Gases, Ltd. Reliant Group, LLC Reliant Holdings, Ltd. Reliant Lonestar Management, LLC Reliant Manufacturing Group, LLC Reliant Manufacturing, Ltd. Reliant Metro Car6onation, LLC Reliant Processing Group, LLC Reliant Processing, Ltd. Reliant Supply Group, LLC Reliant Transportation Group, LLC Reliant Transportation, Ltd. Sandhill Group, LLC The Rice Family Irrevoca6le Trust Rice Partnership Re: 7301 Car6on Dioxide for Water Treatment Facility The ACORD name and logo are registered marks of ACORD O 03-26-2021 2:17 PM Fax r Financial Services Purchasing Division pg 1 of 2 CERTIFICATE OF LIABILITY INSURANCE on� �MMioonvvv� sizeizoz� THIS CERl1FICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICATE HOLDER. lHIS CERlIFICATE DOES NOT AFFIRMAl1VELY OR NEGAlIVELY AMEND, EXTEND OR ALlER THE COVERAGE AFFORDED BY THE POLIqES BELOW. THIS CERl1FICAlE OF INSURANCE DOES NOT CONSlIlUTE A CONTRACT BENVEEN THE ISSUING INSURER�S), AUlHORIZED REPRESENTAl1VE OR PRODUCER, AND THE CERl1FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIlIONAL INSURED, the policy�ies) must have ADDIl10NAL INSURED provisions or be endorsed. If SUBROGAlION 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 riahts to the certificate holder in lieu of such endorsementlsl. PROOUCER Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 75102 iNsuREo Reliant Holdings, Ltd. "List of Named Insureds shown below" 10817 West County Road 60 Midland TX 79707 COVERAGES CERTIFICATE NUMBER: 1564�81089 REVISION NUMBER: 26620 32620 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. INSR AOOL SUBR POLICY EFF POLICY EXP �� TYPEOFINSURANCE POLICYNUMBER MMIOOIYYYY MMIOOIYYYY LIMITS C j�' COMMERCIALGENERALLIABILITY G71795652002 3/26/2021 6/1/2022 EACHOCCURRENCE st,000,aaa CLAIMS-MADE �OCCUR PREMISES�EaaNcurrence $50,000 Y` BI&P� �ecl d1000 MED EXP (Any ane persan) $ 5,000 y` XCLIno[evduded PERSONAL&ADVINJURV $i,000,aaa GEN'LAGGPEGATEIJMITAPPLIESPEP_ GENEPALAGGPEGATE $2,000,000 POLICV � PR� � LOC PRODUCTS-COMP/OPAGG sz,000,aaa JECT OTHER: $ E AUTOMOBILELIABILITY GAL4840019-00 3/26/2021 6/1/2021 COMBINEDSINGLELIMIT g��000,000 Ee eccident j�' ANVAUTO BODILVINJUPV(Perpersan) $ OWNED SGHEDULED BODILV INJUPV (Pereccidenf) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPERTVDAMAGE $ AUTOS ONLV AUTOS ONLV Per accident Y` MCS-3a $ 6 j( UMBRELLALIAB .� OCCUR 42-UM0347368-03 3/2G/2021 6/1/2022 EACHOCCURRENCE $5,000,000 � P-001-444141412-03 3/2G/2021 6/1/2022 X EXCESSLIAB GLAIMS-MADE AGGREGATE $5,000,000 DED X F2ETENTION$ �s,000,000/Gcs S$5,000,000/A p WORKERSCOMPENSATION WC111026505 3/26/2021 3/26/2022 y� PER �. OTH- A ANOEMPLOYERS'LIABILITY ylN WC185582305 3/26/2021 3/26/2022 STATUTE ER AlternateEm la ANVPROPRIEfOR/PARTNER/EXECUTNE p� NIA ELEACHACQDENT si,000,aaa OFFlCER/MEMBER EXC W DE09 �MantlatoryinNH� ELDISEASE-EAEMPLOVEE $1,000,000 fyes, describe under DESCRIPTIONOFOPERATIONSbelaw ELDISEASE-POLICVLIMIT si,000,aaa c conheaors Palluoon LiebiliCj G71795652 002 3/26/2021 6/1/2022 Each qaim $1,OOQ000 Off-Si[� P�lic9qqgrega[e $1,OOQ000 oea�nmi� gia,000 OESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES �ACORO 101, Atltlitional Remarks Schetlule, may be attachetl if more space is requiretl� Primary Um6rella Policy #42UM030736803 $5,000,000/Occurrenc�$5,000,000/Aggregate and Excess Policy Number #P00100010141203 $S,OOD,ODO/Occurrenc�$S,OOO,�OD/Aggregate for a total of $10,OD0,000 in Excess limits. The General Lia6ility, Automobile Lia6ility and Pollution Liability policies include a 6lanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Lia6ility, Automobile Liability, Um6rella Lia6ility, Excess Liability and Workers' Compensation policy indudes a blanket waiver of subrogation endorsement to the certifcate holder when required by wntten contract. See Attached... SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins P.O. Bax 580 Fort Collins CO 80522 Janna Gonzalez, Certificate CSR ,n� 817-34&2384 FpIC. Nol' S'I7-347-EHS'I iNsuRERo: Axis Surplus Insurance Compan� iNsuRER E: National Interstate Insurance Co. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD O 03-26-2021 2:17 PM Fax r Financial Services Purchasing Division pg 2 of 2 AGENCYCUSTOMERID: RELIHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Higginbotham Insurance Agency, Inc. POLICY NUMBER CARRIER ADDIl10NAL REMARKS NAIC COOE NAMEOINSUREO Reliant Holdings, Ltd. "List of Named Insureds shown below" 10E17 West County Road 60 Midland TX 79707 EFFECTIVE OATE: THIS ADDIl10NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM 11TLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 General Liability and Automobile Liability policy has a blanket Primary & Non Contnbutory endorsement that affords that coverage to certifcate holders only �e there is a written contract 6etween the Named Insured and the certifcate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Compensation Policy #WC111026505 Covered States- AL,AR,AZ,CA,CO,GA,IA,KS,MS,NC,NM,TXpK Compensation Policy #W�185582305 Covered States FL,OR Excess liability is underlying the General Liability, Automo6ile Liability and the Employers Lia6ility and follows form on the underlying forthe additional insured. " Supplemental Name " Name Pnnted on DEC Page: Reliant Holdings, Ltd. FL00O2 Management Group, LLC FL00O2, Ltd. Meek Refngeration Inc. RDS Leasing, LLC Reliant Atlantic Group, LLC Reliant Atlantic Group, Ltd Reliant Distri6ution Group, LLC Reliant Distribution, Ltd. Reliant Dry Ice Group, LLC Reliant Dry Ice Pacifiq LLC Reliant Dry Ice, Ltd. Reliant Employment Group, LLC Reliant Employment Services, LTD Reliant Equipment Leasing II, LLC Reliant Equipment Leasing, LLC Reliant Exploration & Production, LLC Reliant Gases, Ltd. Reliant Group, LLC Reliant Holdings, Ltd. Reliant Lonestar Management, LLC Reliant Manufacturing Group, LLC Reliant Manufacturing, Ltd. Reliant Metro Car6onation, LLC Reliant Processing Group, LLC Reliant Processing, Ltd. Reliant Supply Group, LLC Reliant Transportation Group, LLC Reliant Transportation, Ltd. Sandhill Group, LLC The Rice Family Irrevoca6le Trust Rice Partnership RE: Liquid Carbon Dioxide The ACORD name and logo are registered marks of ACORD O 03-26-2021 2:17 PM Fax r Financial Services Purchasing Division pg 1 of 2 CERTIFICATE OF LIABILITY INSURANCE on� �MMioonvvv� sizeizoz� THIS CERl1FICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICATE HOLDER. lHIS CERlIFICATE DOES NOT AFFIRMAl1VELY OR NEGAlIVELY AMEND, EXTEND OR ALlER THE COVERAGE AFFORDED BY THE POLIqES BELOW. THIS CERl1FICAlE OF INSURANCE DOES NOT CONSlIlUTE A CONTRACT BENVEEN THE ISSUING INSURER�S), AUlHORIZED REPRESENTAl1VE OR PRODUCER, AND THE CERl1FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIlIONAL INSURED, the policy�ies) must have ADDIl10NAL INSURED provisions or be endorsed. If SUBROGAlION 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 riahts to the certificate holder in lieu of such endorsementlsl. PROOUCER Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 75102 iNsuREo Reliant Holdings, Ltd. "List of Named Insureds shown below" 10817 West County Road 60 Midland TX 79707 COVERAGES CERTIFICATE NUMBER:2095505453 REVISION NUMBER: 26620 32620 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. INSR AOOL SUBR POLICY EFF POLICY EXP �� TYPEOFINSURANCE POLICYNUMBER MMIOOIYYYY MMIOOIYYYY LIMITS C j�' COMMERCIALGENERALLIABILITY G71795652002 3/26/2021 6/1/2022 EACHOCCURRENCE st,000,aaa CLAIMS-MADE �OCCUR PREMISES�EaaNcurrence $50,000 Y` BI&P� �ecl d1000 MED EXP (Any ane persan) $ 5,000 y` XCLIno[evduded PERSONAL&ADVINJURV $i,000,aaa GEN'LAGGPEGATEIJMITAPPLIESPEP_ GENEPALAGGPEGATE $2,000,000 POLICV � PR� � LOC PRODUCTS-COMP/OPAGG sz,000,aaa JECT OTHER: $ E AUTOMOBILELIABILITY GAL4840019-00 3/26/2021 6/1/2021 COMBINEDSINGLELIMIT g��000,000 Ee eccident j�' ANVAUTO BODILVINJUPV(Perpersan) $ OWNED SGHEDULED BODILV INJUPV (Pereccidenf) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPERTVDAMAGE $ AUTOS ONLV AUTOS ONLV Per accident Y` MCS-3a $ 6 j( UMBRELLALIAB .� OCCUR 42-UM0347368-03 3/2G/2021 6/1/2022 EACHOCCURRENCE $5,000,000 � P-001-444141412-03 3/2G/2021 6/1/2022 X EXCESSLIAB GLAIMS-MADE AGGREGATE $5,000,000 DED X F2ETENTION$ �s,000,000/Gcs S$5,000,000/A p WORKERSCOMPENSATION WC111026505 3/26/2021 3/26/2022 y� PER �. OTH- A ANOEMPLOYERS'LIABILITY ylN WC185582305 3/26/2021 3/26/2022 STATUTE ER AlternateEm la ANVPROPRIEfOR/PARTNER/EXECUTNE p� NIA ELEACHACQDENT si,000,aaa OFFlCER/MEMBER EXC W DE09 �MantlatoryinNH� ELDISEASE-EAEMPLOVEE $1,000,000 fyes, describe under DESCRIPTIONOFOPERATIONSbelaw ELDISEASE-POLICVLIMIT si,000,aaa c conheaors Palluoon LiebiliCj G71795652 002 3/26/2021 6/1/2022 Each qaim $1,OOQ000 Off-Si[� P�lic9qqgrega[e $1,OOQ000 oea�nmi� gia,000 OESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES �ACORO 101, Atltlitional Remarks Schetlule, may be attachetl if more space is requiretl� Primary Um6rella Policy #42UM030736803 $5,000,000/Occurrenc�$5,000,000/Aggregate and Excess Policy Number #P00100010141203 $S,OOD,ODO/Occurrenc�$S,OOO,�OD/Aggregate for a total of $10,OD0,000 in Excess limits. The General Lia6ility, Automobile Lia6ility and Pollution Liability policies include a 6lanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Lia6ility, Automobile Liability, Um6rella Lia6ility, Excess Liability and Workers' Compensation policy indudes a blanket waiver of subrogation endorsement to the certifcate holder when required by wntten contract. See Attached... SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins P.O. Bax 580 Fort Collins CO 80522 Janna Gonzalez, Certificate CSR ,n� 817-34&2384 FpIC. Nol' S'I7-347-EHS'I iNsuRERo: Axis Surplus Insurance Compan� iNsuRER E: National Interstate Insurance Co. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD O 03-26-2021 2:17 PM Fax r Financial Services Purchasing Division pg 2 of 2 AGENCYCUSTOMERID: RELIHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Higginbotham Insurance Agency, Inc. POLICY NUMBER CARRIER ADDIl10NAL REMARKS NAIC COOE NAMEOINSUREO Reliant Holdings, Ltd. "List of Named Insureds shown below" 10E17 West County Road 60 Midland TX 79707 EFFECTIVE OATE: THIS ADDIl10NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM 11TLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 General Liability and Automobile Liability policy has a blanket Primary & Non Contnbutory endorsement that affords that coverage to certifcate holders only �e there is a written contract 6etween the Named Insured and the certifcate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Compensation Policy #WC111026505 Covered States- AL,AR,AZ,CA,CO,GA,IA,KS,MS,NC,NM,TXpK Compensation Policy #W�185582305 Covered States FL,OR Excess liability is underlying the General Liability, Automo6ile Liability and the Employers Lia6ility and follows form on the underlying forthe additional insured. " Supplemental Name " Name Pnnted on DEC Page: Reliant Holdings, Ltd. FL00O2 Management Group, LLC FL00O2, Ltd. Meek Refngeration Inc. RDS Leasing, LLC Reliant Atlantic Group, LLC Reliant Atlantic Group, Ltd Reliant Distri6ution Group, LLC Reliant Distribution, Ltd. Reliant Dry Ice Group, LLC Reliant Dry Ice Pacifiq LLC Reliant Dry Ice, Ltd. Reliant Employment Group, LLC Reliant Employment Services, LTD Reliant Equipment Leasing II, LLC Reliant Equipment Leasing, LLC Reliant Exploration & Production, LLC Reliant Gases, Ltd. Reliant Group, LLC Reliant Holdings, Ltd. Reliant Lonestar Management, LLC Reliant Manufacturing Group, LLC Reliant Manufacturing, Ltd. Reliant Metro Car6onation, LLC Reliant Processing Group, LLC Reliant Processing, Ltd. Reliant Supply Group, LLC Reliant Transportation Group, LLC Reliant Transportation, Ltd. Sandhill Group, LLC The Rice Family Irrevoca6le Trust Rice Partnership The ACORD name and logo are registered marks of ACORD O 06-01-2021 926 AM Fax r City of Fort Collins pg 1 of 2 CERTIFICATE OF LIABILITY INSURANCE on� �MMioonvvv� 6/1 /2021 THIS CERl1FICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICATE HOLDER. lHIS CERlIFICATE DOES NOT AFFIRMAl1VELY OR NEGAlIVELY AMEND, EXTEND OR ALlER THE COVERAGE AFFORDED BY THE POLIqES BELOW. THIS CERl1FICAlE OF INSURANCE DOES NOT CONSlIlUTE A CONTRACT BENVEEN THE ISSUING INSURER�S), AUlHORIZED REPRESENTAl1VE OR PRODUCER, AND THE CERl1FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIlIONAL INSURED, the policy�ies) must have ADDIl10NAL INSURED provisions or be endorsed. If SUBROGAlION 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 riahts to the certificate holder in lieu of such endorsementlsl. PROOUCER Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 75102 iNsuREo Reliant Holdings, Ltd. "List of Named Insureds shown below" 10817 West County Road 60 Midland TX 79707 COVERAGES Janna Gonzalez, Certificate CSR ,n� 817-34&2384 FpIC. Nol' S'I7-347-EHS'I iNsuRERo: Axis Surplus Insurance Compan� iNsuRER E: National Interstate Insurance Co. CERTIFICATE NUMBER:749422103 REVISION NUMBER: 26620 32620 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. INSR AOOL SUBR POLICY EFF POLICY EXP �� TYPEOFINSURANCE POLICYNUMBER MMIOOIYYYY MMIOOIYYYY LIMITS C j�' COMMERCIALGENERALLIABILITY G71795652002 3/26/2021 6/1/2022 EACHOCCURRENCE st,000,aaa CLAIMS-MADE �OCCUR PREMISES�EaaNcurrence $50,000 Y` BI&P� �ecl d1000 MED EXP (Any ane persan) $ 5,000 y` XCLIno[evduded PERSONAL&ADVINJURV $i,000,aaa GEN'LAGGPEGATEIJMITAPPLIESPEP_ GENEPALAGGPEGATE $2,000,000 POLICV � PR� � LOC PRODUCTS-COMP/OPAGG sz,000,aaa JECT OTHER: $ E AUTOMOBILELIABILITY GAL4840019-01 6/1/2021 6/1/2022 COMBINEDSINGLELIMIT g��000,000 Ee eccident j�' ANVAUTO BODILVINJUPV(Perpersan) $ OWNED SGHEDULED BODILV INJUPV (Pereccidenf) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPERTVDAMAGE $ AUTOS ONLV AUTOS ONLV Per accident Y` MCS-3a $ 6 j( UMBRELLALIAB .� OCCUR 42-UM0347368-03 3/2G/2021 6/1/2022 EACHOCCURRENCE $5,000,000 � P-001-444141412-03 3/2G/2021 6/1/2022 X EXCESSLIAB GLAIMS-MADE AGGREGATE $5,000,000 DED X F2ETENTION$ �s,000,000/Gcs S$5,000,000/A p WORKERSCOMPENSATION WC111026505 3/26/2021 3/26/2022 y� PER �. OTH- A ANOEMPLOYERS'LIABILITY ylN WC185582305 3/26/2021 3/26/2022 STATUTE ER AlternateEm la ANVPROPRIEfOR/PARTNER/EXECUTNE p� NIA ELEACHACQDENT si,000,aaa OFFlCER/MEMBER EXC W DE09 �MantlatoryinNH� ELDISEASE-EAEMPLOVEE $1,000,000 fyes, describe under DESCRIPTIONOFOPERATIONSbelaw ELDISEASE-POLICVLIMIT si,000,aaa c conheaors Palluoon LiebiliCj G71795652 002 3/26/2021 6/1/2022 Each qaim $1,OOQ000 Off-Si[� P�lic9qqgrega[e $1,OOQ000 oea�nmi� gia,000 OESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES �ACORO 101, Atltlitional Remarks Schetlule, may be attachetl if more space is requiretl� Primary Um6rella Policy #42UM030736803 $5,000,000/Occurrenc�$5,000,000/Aggregate and Excess Policy Number #P00100010141203 $S,OOD,ODO/Occurrenc�$S,OOO,�OD/Aggregate for a total of $10,OD0,000 in Excess limits. The General Lia6ility, Automobile Lia6ility and Pollution Liability policies include a 6lanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Lia6ility, Automobile Liability, Um6rella Lia6ility, Excess Liability and Workers' Compensation policy indudes a blanket waiver of subrogation endorsement to the certifcate holder when required by wntten contract. See Attached... SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins PO Box 580 Fort Collins CO 80522 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD O 06-01-2021 926 AM Fax r City of Fort Collins pg 2 of 2 AGENCYCUSTOMERID: RELIHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Higginbotham Insurance Agency, Inc. POLICY NUMBER CARRIER ADDIl10NAL REMARKS NAIC COOE NAMEOINSUREO Reliant Holdings, Ltd. "List of Named Insureds shown below" 10E17 West County Road 60 Midland TX 79707 EFFECTIVE OATE: THIS ADDIl10NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM 11TLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 General Liability and Automobile Liability policy has a blanket Primary & Non Contnbutory endorsement that affords that coverage to certifcate holders only �e there is a written contract 6etween the Named Insured and the certifcate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Compensation Policy #WC111026505 Covered States- AL,AR,AZ,CA,CO,GA,IA,KS,MS,NC,NM,TXpK Compensation Policy #W�185582305 Covered States FL,OR Excess liability is underlying the General Liability, Automo6ile Liability and the Employers Lia6ility and follows form on the underlying forthe additional insured. " Supplemental Name " Name Pnnted on DEC Page: Reliant Holdings, Ltd. FL00O2 Management Group, LLC FL00O2, Ltd. Meek Refngeration Inc. RDS Leasing, LLC Reliant Atlantic Group, LLC Reliant Atlantic Group, Ltd Reliant Distri6ution Group, LLC Reliant Distribution, Ltd. Reliant Dry Ice Group, LLC Reliant Dry Ice Pacifiq LLC Reliant Dry Ice, Ltd. Reliant Employment Group, LLC Reliant Employment Services, LTD Reliant Equipment Leasing II, LLC Reliant Equipment Leasing, LLC Reliant Exploration & Production, LLC Reliant Gases, Ltd. Reliant Group, LLC Reliant Holdings, Ltd. Reliant Lonestar Management, LLC Reliant Manufacturing Group, LLC Reliant Manufacturing, Ltd. Reliant Metro Car6onation, LLC Reliant Processing Group, LLC Reliant Processing, Ltd. Reliant Supply Group, LLC Reliant Transportation Group, LLC Reliant Transportation, Ltd. Sandhill Group, LLC The Rice Family Irrevoca6le Trust Rice Partnership Re: 7301 Car6on Dioxide for Water Treatment Facility The ACORD name and logo are registered marks of ACORD O 06-01-2021 927 AM Fax r Financial Services Purchasing Division pg 1 of 2 CERTIFICATE OF LIABILITY INSURANCE on� �MMioonvvv� 6/1 /2021 THIS CERl1FICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICATE HOLDER. lHIS CERlIFICATE DOES NOT AFFIRMAl1VELY OR NEGAlIVELY AMEND, EXTEND OR ALlER THE COVERAGE AFFORDED BY THE POLIqES BELOW. THIS CERl1FICAlE OF INSURANCE DOES NOT CONSlIlUTE A CONTRACT BENVEEN THE ISSUING INSURER�S), AUlHORIZED REPRESENTAl1VE OR PRODUCER, AND THE CERl1FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIlIONAL INSURED, the policy�ies) must have ADDIl10NAL INSURED provisions or be endorsed. If SUBROGAlION 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 riahts to the certificate holder in lieu of such endorsementlsl. PROOUCER Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 75102 iNsuREo Reliant Holdings, Ltd. "List of Named Insureds shown below" 10817 West County Road 60 Midland TX 79707 COVERAGES CERTIFICATE NUMBER: 1102807192 REVISION NUMBER: 26620 32620 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. INSR AOOL SUBR POLICY EFF POLICY EXP �� TYPEOFINSURANCE POLICYNUMBER MMIOOIYYYY MMIOOIYYYY LIMITS C j�' COMMERCIALGENERALLIABILITY G71795652002 3/26/2021 6/1/2022 EACHOCCURRENCE st,000,aaa CLAIMS-MADE �OCCUR PREMISES�EaaNcurrence $50,000 Y` BI&P� �ecl d1000 MED EXP (Any ane persan) $ 5,000 y` XCLIno[evduded PERSONAL&ADVINJURV $i,000,aaa GEN'LAGGPEGATEIJMITAPPLIESPEP_ GENEPALAGGPEGATE $2,000,000 POLICV � PR� � LOC PRODUCTS-COMP/OPAGG sz,000,aaa JECT OTHER: $ E AUTOMOBILELIABILITY GAL4840019-01 6/1/2021 6/1/2022 COMBINEDSINGLELIMIT g��000,000 Ee eccident j�' ANVAUTO BODILVINJUPV(Perpersan) $ OWNED SGHEDULED BODILV INJUPV (Pereccidenf) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPERTVDAMAGE $ AUTOS ONLV AUTOS ONLV Per accident Y` MCS-3a $ 6 j( UMBRELLALIAB .� OCCUR 42-UM0347368-03 3/2G/2021 6/1/2022 EACHOCCURRENCE $5,000,000 � P-001-444141412-03 3/2G/2021 6/1/2022 X EXCESSLIAB GLAIMS-MADE AGGREGATE $5,000,000 DED X F2ETENTION$ �s,000,000/Gcs S$5,000,000/A p WORKERSCOMPENSATION WC111026505 3/26/2021 3/26/2022 y� PER �. OTH- A ANOEMPLOYERS'LIABILITY ylN WC185582305 3/26/2021 3/26/2022 STATUTE ER AlternateEm la ANVPROPRIEfOR/PARTNER/EXECUTNE p� NIA ELEACHACQDENT si,000,aaa OFFlCER/MEMBER EXC W DE09 �MantlatoryinNH� ELDISEASE-EAEMPLOVEE $1,000,000 fyes, describe under DESCRIPTIONOFOPERATIONSbelaw ELDISEASE-POLICVLIMIT si,000,aaa c conheaors Palluoon LiebiliCj G71795652 002 3/26/2021 6/1/2022 Each qaim $1,OOQ000 Off-Si[� P�lic9qqgrega[e $1,OOQ000 oea�nmi� gia,000 OESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES �ACORO 101, Atltlitional Remarks Schetlule, may be attachetl if more space is requiretl� Primary Um6rella Policy #42UM030736803 $5,000,000/Occurrenc�$5,000,000/Aggregate and Excess Policy Number #P00100010141203 $S,OOD,ODO/Occurrenc�$S,OOO,�OD/Aggregate for a total of $10,OD0,000 in Excess limits. The General Lia6ility, Automobile Lia6ility and Pollution Liability policies include a 6lanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Lia6ility, Automobile Liability, Um6rella Lia6ility, Excess Liability and Workers' Compensation policy indudes a blanket waiver of subrogation endorsement to the certifcate holder when required by wntten contract. See Attached... SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins P.O. Bax 580 Fort Collins CO 80522 Janna Gonzalez, Certificate CSR ,n� 817-34&2384 FpIC. Nol' S'I7-347-EHS'I iNsuRERo: Axis Surplus Insurance Compan� iNsuRER E: National Interstate Insurance Co. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD O 06-01-2021 927 AM Fax r Financial Services Purchasing Division pg 2 of 2 AGENCYCUSTOMERID: RELIHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Higginbotham Insurance Agency, Inc. POLICY NUMBER CARRIER ADDIl10NAL REMARKS NAIC COOE NAMEOINSUREO Reliant Holdings, Ltd. "List of Named Insureds shown below" 10E17 West County Road 60 Midland TX 79707 EFFECTIVE OATE: THIS ADDIl10NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM 11TLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 General Liability and Automobile Liability policy has a blanket Primary & Non Contnbutory endorsement that affords that coverage to certifcate holders only �e there is a written contract 6etween the Named Insured and the certifcate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Compensation Policy #WC111026505 Covered States- AL,AR,AZ,CA,CO,GA,IA,KS,MS,NC,NM,TXpK Compensation Policy #W�185582305 Covered States FL,OR Excess liability is underlying the General Liability, Automo6ile Liability and the Employers Lia6ility and follows form on the underlying forthe additional insured. " Supplemental Name " Name Pnnted on DEC Page: Reliant Holdings, Ltd. FL00O2 Management Group, LLC FL00O2, Ltd. Meek Refngeration Inc. RDS Leasing, LLC Reliant Atlantic Group, LLC Reliant Atlantic Group, Ltd Reliant Distri6ution Group, LLC Reliant Distribution, Ltd. Reliant Dry Ice Group, LLC Reliant Dry Ice Pacifiq LLC Reliant Dry Ice, Ltd. Reliant Employment Group, LLC Reliant Employment Services, LTD Reliant Equipment Leasing II, LLC Reliant Equipment Leasing, LLC Reliant Exploration & Production, LLC Reliant Gases, Ltd. Reliant Group, LLC Reliant Holdings, Ltd. Reliant Lonestar Management, LLC Reliant Manufacturing Group, LLC Reliant Manufacturing, Ltd. Reliant Metro Car6onation, LLC Reliant Processing Group, LLC Reliant Processing, Ltd. Reliant Supply Group, LLC Reliant Transportation Group, LLC Reliant Transportation, Ltd. Sandhill Group, LLC The Rice Family Irrevoca6le Trust Rice Partnership The ACORD name and logo are registered marks of ACORD O 06-01-2021 9:32 AM Fax r Financial Services Purchasing Division pg 1 of 2 CERTIFICATE OF LIABILITY INSURANCE on� �MMioonvvv� 6/1 /2021 THIS CERl1FICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICATE HOLDER. lHIS CERlIFICATE DOES NOT AFFIRMAl1VELY OR NEGAlIVELY AMEND, EXTEND OR ALlER THE COVERAGE AFFORDED BY THE POLIqES BELOW. THIS CERl1FICAlE OF INSURANCE DOES NOT CONSlIlUTE A CONTRACT BENVEEN THE ISSUING INSURER�S), AUlHORIZED REPRESENTAl1VE OR PRODUCER, AND THE CERl1FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIlIONAL INSURED, the policy�ies) must have ADDIl10NAL INSURED provisions or be endorsed. If SUBROGAlION 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 riahts to the certificate holder in lieu of such endorsementlsl. PROOUCER Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 75102 iNsuREo Reliant Holdings, Ltd. "List of Named Insureds shown below" 10817 West County Road 60 Midland TX 79707 COVERAGES CERTIFICATE NUMBER: 1530544103 REVISION NUMBER: 26620 32620 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. INSR AOOL SUBR POLICY EFF POLICY EXP �� TYPEOFINSURANCE POLICYNUMBER MMIOOIYYYY MMIOOIYYYY LIMITS C j�' COMMERCIALGENERALLIABILITY G71795652002 3/26/2021 6/1/2022 EACHOCCURRENCE st,000,aaa CLAIMS-MADE �OCCUR PREMISES�EaaNcurrence $50,000 Y` BI&P� �ecl d1000 MED EXP (Any ane persan) $ 5,000 y` XCLIno[evduded PERSONAL&ADVINJURV $i,000,aaa GEN'LAGGPEGATEIJMITAPPLIESPEP_ GENEPALAGGPEGATE $2,000,000 POLICV � PR� � LOC PRODUCTS-COMP/OPAGG sz,000,aaa JECT OTHER: $ E AUTOMOBILELIABILITY GAL4840019-01 6/1/2021 6/1/2022 COMBINEDSINGLELIMIT g��000,000 Ee eccident j�' ANVAUTO BODILVINJUPV(Perpersan) $ OWNED SGHEDULED BODILV INJUPV (Pereccidenf) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPERTVDAMAGE $ AUTOS ONLV AUTOS ONLV Per accident Y` MCS-3a $ 6 j( UMBRELLALIAB .� OCCUR 42-UM0347368-03 3/2G/2021 6/1/2022 EACHOCCURRENCE $5,000,000 � P-001-444141412-03 3/2G/2021 6/1/2022 X EXCESSLIAB GLAIMS-MADE AGGREGATE $5,000,000 DED X F2ETENTION$ �s,000,000/Gcs S$5,000,000/A p WORKERSCOMPENSATION WC111026505 3/26/2021 3/26/2022 y� PER �. OTH- A ANOEMPLOYERS'LIABILITY ylN WC185582305 3/26/2021 3/26/2022 STATUTE ER AlternateEm la ANVPROPRIEfOR/PARTNER/EXECUTNE p� NIA ELEACHACQDENT si,000,aaa OFFlCER/MEMBER EXC W DE09 �MantlatoryinNH� ELDISEASE-EAEMPLOVEE $1,000,000 fyes, describe under DESCRIPTIONOFOPERATIONSbelaw ELDISEASE-POLICVLIMIT si,000,aaa c conheaors Palluoon LiebiliCj G71795652 002 3/26/2021 6/1/2022 Each qaim $1,OOQ000 Off-Si[� P�lic9qqgrega[e $1,OOQ000 oea�nmi� gia,000 OESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES �ACORO 101, Atltlitional Remarks Schetlule, may be attachetl if more space is requiretl� Primary Um6rella Policy #42UM030736803 $5,000,000/Occurrenc�$5,000,000/Aggregate and Excess Policy Number #P00100010141203 $S,OOD,ODO/Occurrenc�$S,OOO,�OD/Aggregate for a total of $10,OD0,000 in Excess limits. The General Lia6ility, Automobile Lia6ility and Pollution Liability policies include a 6lanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Lia6ility, Automobile Liability, Um6rella Lia6ility, Excess Liability and Workers' Compensation policy indudes a blanket waiver of subrogation endorsement to the certifcate holder when required by wntten contract. See Attached... SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins P.O. Bax 580 Fort Collins CO 80522 Janna Gonzalez, Certificate CSR ,n� 817-34&2384 FpIC. Nol' S'I7-347-EHS'I iNsuRERo: Axis Surplus Insurance Compan� iNsuRER E: National Interstate Insurance Co. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD O 06-01-2021 9:32 AM Fax r Financial Services Purchasing Division pg 2 of 2 AGENCYCUSTOMERID: RELIHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Higginbotham Insurance Agency, Inc. POLICY NUMBER CARRIER ADDIl10NAL REMARKS NAIC COOE NAMEOINSUREO Reliant Holdings, Ltd. "List of Named Insureds shown below" 10E17 West County Road 60 Midland TX 79707 EFFECTIVE OATE: THIS ADDIl10NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM 11TLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 General Liability and Automobile Liability policy has a blanket Primary & Non Contnbutory endorsement that affords that coverage to certifcate holders only �e there is a written contract 6etween the Named Insured and the certifcate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Compensation Policy #WC111026505 Covered States- AL,AR,AZ,CA,CO,GA,IA,KS,MS,NC,NM,TXpK Compensation Policy #W�185582305 Covered States FL,OR Excess liability is underlying the General Liability, Automo6ile Liability and the Employers Lia6ility and follows form on the underlying forthe additional insured. " Supplemental Name " Name Pnnted on DEC Page: Reliant Holdings, Ltd. FL00O2 Management Group, LLC FL00O2, Ltd. Meek Refngeration Inc. RDS Leasing, LLC Reliant Atlantic Group, LLC Reliant Atlantic Group, Ltd Reliant Distri6ution Group, LLC Reliant Distribution, Ltd. Reliant Dry Ice Group, LLC Reliant Dry Ice Pacifiq LLC Reliant Dry Ice, Ltd. Reliant Employment Group, LLC Reliant Employment Services, LTD Reliant Equipment Leasing II, LLC Reliant Equipment Leasing, LLC Reliant Exploration & Production, LLC Reliant Gases, Ltd. Reliant Group, LLC Reliant Holdings, Ltd. Reliant Lonestar Management, LLC Reliant Manufacturing Group, LLC Reliant Manufacturing, Ltd. Reliant Metro Car6onation, LLC Reliant Processing Group, LLC Reliant Processing, Ltd. Reliant Supply Group, LLC Reliant Transportation Group, LLC Reliant Transportation, Ltd. Sandhill Group, LLC The Rice Family Irrevoca6le Trust Rice Partnership RE: Liquid Carbon Dioxide The ACORD name and logo are registered marks of ACORD O 03-31-2022 1225 PM Fax r Financial Services Purchasing Division pg 1 of 2 CERTIFICATE OF LIABILITY INSURANCE on� �MMioonvvv� sis� izozz THIS CERl1FICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICATE HOLDER. lHIS CERlIFICATE DOES NOT AFFIRMAl1VELY OR NEGAlIVELY AMEND, EXTEND OR ALlER THE COVERAGE AFFORDED BY THE POLIqES BELOW. THIS CERl1FICAlE OF INSURANCE DOES NOT CONSlIlUTE A CONTRACT BENVEEN THE ISSUING INSURER�S), AUlHORIZED REPRESENTAl1VE OR PRODUCER, AND THE CERl1FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIlIONAL INSURED, the policy�ies) must have ADDIl10NAL INSURED provisions or be endorsed. If SUBROGAlION 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 riahts to the certificate holder in lieu of such endorsementlsl. PROOUCER Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 75102 iNsuREo Reliant Holdings, Ltd. "List of Named Insureds shown below" 10817 West County Road 60 Midland TX 79707 COVERAGES CERTIFICATE NUMBER: 146763�099 REVISION NUMBER: 26620 32620 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. INSR AOOL SUBR POLICY EFF POLICY EXP �� TYPEOFINSURANCE POLICYNUMBER MMIOOIYYYY MMIOOIYYYY LIMITS C j�' COMMERCIALGENERALLIABILITY G71795652002 3/26/2021 6/1/2022 EACHOCCURRENCE st,000,aaa CLAIMS-MADE �OCCUR PREMISES�EaaNcurrence $50,000 Y` BI&P� �ecl d1000 MED EXP (Any ane persan) $ 5,000 y` XCLIno[evduded PERSONAL&ADVINJURV $i,000,aaa GEN'LAGGPEGATEIJMITAPPLIESPEP_ GENEPALAGGPEGATE $2,000,000 POLICV � PR� � LOC PRODUCTS-COMP/OPAGG sz,000,aaa JECT OTHER: $ E AUTOMOBILELIABILITY GAL4840019-01 6/1/2021 6/1/2022 COMBINEDSINGLELIMIT g��000,000 Ee eccident j�' ANVAUTO BODILVINJUPV(Perpersan) $ OWNED SGHEDULED BODILV INJUPV (Pereccidenf) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPERTVDAMAGE $ AUTOS ONLV AUTOS ONLV Per accident Y` MCS-3a $ 6 j( UMBRELLALIAB .� OCCUR 42-UM0347368-03 3/2G/2021 6/1/2022 EACHOCCURRENCE $5,000,000 � P-001-444141412-03 3/2G/2021 6/1/2022 X EXCESSLIAB GLAIMS-MADE AGGREGATE $5,000,000 DED X F2ETENTION$ �s,000,000/Gcs S$5,000,000/A p WORKERSCOMPENSATION WC111026506 3/26/2022 6/1/2022 y� PER �. OTH- A ANOEMPLOYERS'LIABILITY ylN WC185582306 3/26/2022 6/1/2022 STATUTE ER AlternateEm la ANVPROPRIEfOR/PARTNER/EXECUTNE p� NIA ELEACHACQDENT si,000,aaa OFFlCER/MEMBER EXC W DE09 �MantlatoryinNH� ELDISEASE-EAEMPLOVEE $1,000,000 fyes, describe under DESCRIPTIONOFOPERATIONSbelaw ELDISEASE-POLICVLIMIT si,000,aaa c conheaors Palluoon LiebiliCj G71795652 002 3/26/2021 6/1/2022 Each qaim $1,OOQ000 Off-Si[� P�lic9qqgrega[e $1,OOQ000 oea�nmi� gia,000 OESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES �ACORO 101, Atltlitional Remarks Schetlule, may be attachetl if more space is requiretl� Primary Um6rella Policy #42UM030736803 $5,000,000/Occurrenc�$5,000,000/Aggregate and Excess Policy Number #P00100010141203 $S,OOD,ODO/Occurrenc�$S,OOO,�OD/Aggregate for a total of $10,OD0,000 in Excess limits. The General Lia6ility, Automobile Lia6ility and Pollution Liability policies include a 6lanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Lia6ility, Automobile Liability, Um6rella Lia6ility, Excess Liability and Workers' Compensation policy indudes a blanket waiver of subrogation endorsement to the certifcate holder when required by wntten contract. See Attached... SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins P.O. Bax 580 Fort Collins CO 80522 Janna Gonzalez, Certificate CSR ,n� 817-34&2384 FpIC. Nol' S'I7-347-EHS'I iNsuRERo: Axis Surplus Insurance Compan� iNsuRER E: National Interstate Insurance Co. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD O 03-31-2022 1225 PM Fax r Financial Services Purchasing Division pg 2 of 2 AGENCYCUSTOMERID: RELIHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Higginbotham Insurance Agency, Inc. POLICY NUMBER CARRIER ADDIl10NAL REMARKS NAIC COOE NAMEOINSUREO Reliant Holdings, Ltd. "List of Named Insureds shown below" 10E17 West County Road 60 Midland TX 79707 EFFECTIVE OATE: THIS ADDIl10NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM 11TLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 General Liability and Automobile Liability policy has a blanket Primary & Non Contnbutory endorsement that affords that coverage to certifcate holders only �e there is a written contract 6etween the Named Insured and the certifcate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Compensation Policy #WC111026505 Covered States- AL,AR,AZ,CA,CO,GA,IA,KS,MS,NC,NM,TXpK Compensation Policy #W�185582305 Covered States FL,OR Excess liability is underlying the General Liability, Automo6ile Liability and the Employers Lia6ility and follows form on the underlying forthe additional insured. " Supplemental Name " Name Pnnted on DEC Page: Reliant Holdings, Ltd. FL00O2 Management Group, LLC FL00O2, Ltd. Meek Refngeration Inc. RDS Leasing, LLC Reliant Atlantic Group, LLC Reliant Atlantic Group, Ltd Reliant Distri6ution Group, LLC Reliant Distribution, Ltd. Reliant Dry Ice Group, LLC Reliant Dry Ice Pacifiq LLC Reliant Dry Ice, Ltd. Reliant Employment Group, LLC Reliant Employment Services, LTD Reliant Equipment Leasing II, LLC Reliant Equipment Leasing, LLC Reliant Exploration & Production, LLC Reliant Gases, Ltd. Reliant Group, LLC Reliant Holdings, Ltd. Reliant Lonestar Management, LLC Reliant Manufacturing Group, LLC Reliant Manufacturing, Ltd. Reliant Metro Car6onation, LLC Reliant Processing Group, LLC Reliant Processing, Ltd. Reliant Supply Group, LLC Reliant Transportation Group, LLC Reliant Transportation, Ltd. Sandhill Group, LLC The Rice Family Irrevoca6le Trust Rice Partnership RE: Liquid Carbon Dioxide The ACORD name and logo are registered marks of ACORD O 03-31-2022 1225 PM Fax r Financial Services Purchasing Division pg 1 of 2 CERTIFICATE OF LIABILITY INSURANCE on� �MMioonvvv� sis� izozz THIS CERl1FICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICATE HOLDER. lHIS CERlIFICATE DOES NOT AFFIRMAl1VELY OR NEGAlIVELY AMEND, EXTEND OR ALlER THE COVERAGE AFFORDED BY THE POLIqES BELOW. THIS CERl1FICAlE OF INSURANCE DOES NOT CONSlIlUTE A CONTRACT BENVEEN THE ISSUING INSURER�S), AUlHORIZED REPRESENTAl1VE OR PRODUCER, AND THE CERl1FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIlIONAL INSURED, the policy�ies) must have ADDIl10NAL INSURED provisions or be endorsed. If SUBROGAlION 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 riahts to the certificate holder in lieu of such endorsementlsl. PROOUCER Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 75102 iNsuREo Reliant Holdings, Ltd. "List of Named Insureds shown below" 10817 West County Road 60 Midland TX 79707 COVERAGES Janna Gonzalez, Certificate CSR ,n� 817-34&2384 FpIC. Nol' S'I7-347-EHS'I iNsuRERo: Axis Surplus Insurance Compan� iNsuRER E: National Interstate Insurance Co. CERTIFICATE NUMBER:899345210 REVISION NUMBER: 26620 32620 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. INSR AOOL SUBR POLICY EFF POLICY EXP �� TYPEOFINSURANCE POLICYNUMBER MMIOOIYYYY MMIOOIYYYY LIMITS C j�' COMMERCIALGENERALLIABILITY G71795652002 3/26/2021 6/1/2022 EACHOCCURRENCE st,000,aaa CLAIMS-MADE �OCCUR PREMISES�EaaNcurrence $50,000 Y` BI&P� �ecl d1000 MED EXP (Any ane persan) $ 5,000 y` XCLIno[evduded PERSONAL&ADVINJURV $i,000,aaa GEN'LAGGPEGATEIJMITAPPLIESPEP_ GENEPALAGGPEGATE $2,000,000 POLICV � PR� � LOC PRODUCTS-COMP/OPAGG sz,000,aaa JECT OTHER: $ E AUTOMOBILELIABILITY GAL4840019-01 6/1/2021 6/1/2022 COMBINEDSINGLELIMIT g��000,000 Ee eccident j�' ANVAUTO BODILVINJUPV(Perpersan) $ OWNED SGHEDULED BODILV INJUPV (Pereccidenf) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPERTVDAMAGE $ AUTOS ONLV AUTOS ONLV Per accident Y` MCS-3a $ 6 j( UMBRELLALIAB .� OCCUR 42-UM0347368-03 3/2G/2021 6/1/2022 EACHOCCURRENCE $5,000,000 � P-001-444141412-03 3/2G/2021 6/1/2022 X EXCESSLIAB GLAIMS-MADE AGGREGATE $5,000,000 DED X F2ETENTION$ �s,000,000/Gcs S$5,000,000/A p WORKERSCOMPENSATION WC111026506 3/26/2022 6/1/2022 y� PER �. OTH- A ANOEMPLOYERS'LIABILITY ylN WC185582306 3/26/2022 6/1/2022 STATUTE ER AlternateEm la ANVPROPRIEfOR/PARTNER/EXECUTNE p� NIA ELEACHACQDENT si,000,aaa OFFlCER/MEMBER EXC W DE09 �MantlatoryinNH� ELDISEASE-EAEMPLOVEE $1,000,000 fyes, describe under DESCRIPTIONOFOPERATIONSbelaw ELDISEASE-POLICVLIMIT si,000,aaa c conheaors Palluoon LiebiliCj G71795652 002 3/26/2021 6/1/2022 Each qaim $1,OOQ000 Off-Si[� P�lic9qqgrega[e $1,OOQ000 oea�nmi� gia,000 OESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES �ACORO 101, Atltlitional Remarks Schetlule, may be attachetl if more space is requiretl� Primary Um6rella Policy #42UM030736803 $5,000,000/Occurrenc�$5,000,000/Aggregate and Excess Policy Number #P00100010141203 $S,OOD,ODO/Occurrenc�$S,OOO,�OD/Aggregate for a total of $10,OD0,000 in Excess limits. The General Lia6ility, Automobile Lia6ility and Pollution Liability policies include a 6lanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Lia6ility, Automobile Liability, Um6rella Lia6ility, Excess Liability and Workers' Compensation policy indudes a blanket waiver of subrogation endorsement to the certifcate holder when required by wntten contract. See Attached... SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins P.O. Bax 580 Fort Collins CO 80522 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD O 03-31-2022 1225 PM Fax r Financial Services Purchasing Division pg 2 of 2 AGENCYCUSTOMERID: RELIHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Higginbotham Insurance Agency, Inc. POLICY NUMBER CARRIER ADDIl10NAL REMARKS NAIC COOE NAMEOINSUREO Reliant Holdings, Ltd. "List of Named Insureds shown below" 10E17 West County Road 60 Midland TX 79707 EFFECTIVE OATE: THIS ADDIl10NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM 11TLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 General Liability and Automobile Liability policy has a blanket Primary & Non Contnbutory endorsement that affords that coverage to certifcate holders only �e there is a written contract 6etween the Named Insured and the certifcate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Compensation Policy #WC111026505 Covered States- AL,AR,AZ,CA,CO,GA,IA,KS,MS,NC,NM,TXpK Compensation Policy #W�185582305 Covered States FL,OR Excess liability is underlying the General Liability, Automo6ile Liability and the Employers Lia6ility and follows form on the underlying forthe additional insured. " Supplemental Name " Name Pnnted on DEC Page: Reliant Holdings, Ltd. FL00O2 Management Group, LLC FL00O2, Ltd. Meek Refngeration Inc. RDS Leasing, LLC Reliant Atlantic Group, LLC Reliant Atlantic Group, Ltd Reliant Distri6ution Group, LLC Reliant Distribution, Ltd. Reliant Dry Ice Group, LLC Reliant Dry Ice Pacifiq LLC Reliant Dry Ice, Ltd. Reliant Employment Group, LLC Reliant Employment Services, LTD Reliant Equipment Leasing II, LLC Reliant Equipment Leasing, LLC Reliant Exploration & Production, LLC Reliant Gases, Ltd. Reliant Group, LLC Reliant Holdings, Ltd. Reliant Lonestar Management, LLC Reliant Manufacturing Group, LLC Reliant Manufacturing, Ltd. Reliant Metro Car6onation, LLC Reliant Processing Group, LLC Reliant Processing, Ltd. Reliant Supply Group, LLC Reliant Transportation Group, LLC Reliant Transportation, Ltd. Sandhill Group, LLC The Rice Family Irrevoca6le Trust Rice Partnership The ACORD name and logo are registered marks of ACORD O 03-31-2022 1226 PM Fax r City of Fort Collins pg 1 of 2 CERTIFICATE OF LIABILITY INSURANCE on� �MMioonvvv� sis� izozz THIS CERl1FICATE IS ISSUED AS A MATTER OF INFORMAl10N ONLY AND CONFERS NO RIGHTS UPON THE CERl1FICATE HOLDER. lHIS CERlIFICATE DOES NOT AFFIRMAl1VELY OR NEGAlIVELY AMEND, EXTEND OR ALlER THE COVERAGE AFFORDED BY THE POLIqES BELOW. THIS CERl1FICAlE OF INSURANCE DOES NOT CONSlIlUTE A CONTRACT BENVEEN THE ISSUING INSURER�S), AUlHORIZED REPRESENTAl1VE OR PRODUCER, AND THE CERl1FICATE HOLDER. IMPORTANT: If the certificate holder is an ADDIlIONAL INSURED, the policy�ies) must have ADDIl10NAL INSURED provisions or be endorsed. If SUBROGAlION 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 riahts to the certificate holder in lieu of such endorsementlsl. PROOUCER Higginbotham Insurance Agency, Inc. 500 W. 13th Street Fort Worth TX 75102 iNsuREo Reliant Holdings, Ltd. "List of Named Insureds shown below" 10817 West County Road 60 Midland TX 79707 COVERAGES CERTIFICATE NUMBER: 1864223409 REVISION NUMBER: 26620 32620 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. INSR AOOL SUBR POLICY EFF POLICY EXP �� TYPEOFINSURANCE POLICYNUMBER MMIOOIYYYY MMIOOIYYYY LIMITS C j�' COMMERCIALGENERALLIABILITY G71795652002 3/26/2021 6/1/2022 EACHOCCURRENCE st,000,aaa CLAIMS-MADE �OCCUR PREMISES�EaaNcurrence $50,000 Y` BI&P� �ecl d1000 MED EXP (Any ane persan) $ 5,000 y` XCLIno[evduded PERSONAL&ADVINJURV $i,000,aaa GEN'LAGGPEGATEIJMITAPPLIESPEP_ GENEPALAGGPEGATE $2,000,000 POLICV � PR� � LOC PRODUCTS-COMP/OPAGG sz,000,aaa JECT OTHER: $ E AUTOMOBILELIABILITY GAL4840019-01 6/1/2021 6/1/2022 COMBINEDSINGLELIMIT g��000,000 Ee eccident j�' ANVAUTO BODILVINJUPV(Perpersan) $ OWNED SGHEDULED BODILV INJUPV (Pereccidenf) $ AUTOSONLV AUTOS HIRED NON-OWNED PROPERTVDAMAGE $ AUTOS ONLV AUTOS ONLV Per accident Y` MCS-3a $ 6 j( UMBRELLALIAB .� OCCUR 42-UM0347368-03 3/2G/2021 6/1/2022 EACHOCCURRENCE $5,000,000 � P-001-444141412-03 3/2G/2021 6/1/2022 X EXCESSLIAB GLAIMS-MADE AGGREGATE $5,000,000 DED X F2ETENTION$ �s,000,000/Gcs S$5,000,000/A p WORKERSCOMPENSATION WC111026506 3/26/2022 6/1/2022 y� PER �. OTH- A ANOEMPLOYERS'LIABILITY ylN WC185582306 3/26/2022 6/1/2022 STATUTE ER AlternateEm la ANVPROPRIEfOR/PARTNER/EXECUTNE p� NIA ELEACHACQDENT si,000,aaa OFFlCER/MEMBER EXC W DE09 �MantlatoryinNH� ELDISEASE-EAEMPLOVEE $1,000,000 fyes, describe under DESCRIPTIONOFOPERATIONSbelaw ELDISEASE-POLICVLIMIT si,000,aaa c conheaors Palluoon LiebiliCj G71795652 002 3/26/2021 6/1/2022 Each qaim $1,OOQ000 Off-Si[� P�lic9qqgrega[e $1,OOQ000 oea�nmi� gia,000 OESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES �ACORO 101, Atltlitional Remarks Schetlule, may be attachetl if more space is requiretl� Primary Um6rella Policy #42UM030736803 $5,000,000/Occurrenc�$5,000,000/Aggregate and Excess Policy Number #P00100010141203 $S,OOD,ODO/Occurrenc�$S,OOO,�OD/Aggregate for a total of $10,OD0,000 in Excess limits. The General Lia6ility, Automobile Lia6ility and Pollution Liability policies include a 6lanket automatic additional (includes completed operations) insured endorsement that provides additional insured status and General Lia6ility, Automobile Liability, Um6rella Lia6ility, Excess Liability and Workers' Compensation policy indudes a blanket waiver of subrogation endorsement to the certifcate holder when required by wntten contract. See Attached... SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins PO Box 580 Fort Collins CO 80522 Janna Gonzalez, Certificate CSR ,n� 817-34&2384 FpIC. Nol' S'I7-347-EHS'I iNsuRERo: Axis Surplus Insurance Compan� iNsuRER E: National Interstate Insurance Co. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD O 03-31-2022 1226 PM Fax r City of Fort Collins pg 2 of 2 AGENCYCUSTOMERID: RELIHOL-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Higginbotham Insurance Agency, Inc. POLICY NUMBER CARRIER ADDIl10NAL REMARKS NAIC COOE NAMEOINSUREO Reliant Holdings, Ltd. "List of Named Insureds shown below" 10E17 West County Road 60 Midland TX 79707 EFFECTIVE OATE: THIS ADDIl10NAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: �5 FORM 11TLE: CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 General Liability and Automobile Liability policy has a blanket Primary & Non Contnbutory endorsement that affords that coverage to certifcate holders only �e there is a written contract 6etween the Named Insured and the certifcate holder that requires such status. The Workers' Compensation policy has a blanket Alternate Employer endorsement. Compensation Policy #WC111026505 Covered States- AL,AR,AZ,CA,CO,GA,IA,KS,MS,NC,NM,TXpK Compensation Policy #W�185582305 Covered States FL,OR Excess liability is underlying the General Liability, Automo6ile Liability and the Employers Lia6ility and follows form on the underlying forthe additional insured. " Supplemental Name " Name Pnnted on DEC Page: Reliant Holdings, Ltd. FL00O2 Management Group, LLC FL00O2, Ltd. Meek Refngeration Inc. RDS Leasing, LLC Reliant Atlantic Group, LLC Reliant Atlantic Group, Ltd Reliant Distri6ution Group, LLC Reliant Distribution, Ltd. Reliant Dry Ice Group, LLC Reliant Dry Ice Pacifiq LLC Reliant Dry Ice, Ltd. Reliant Employment Group, LLC Reliant Employment Services, LTD Reliant Equipment Leasing II, LLC Reliant Equipment Leasing, LLC Reliant Exploration & Production, LLC Reliant Gases, Ltd. Reliant Group, LLC Reliant Holdings, Ltd. Reliant Lonestar Management, LLC Reliant Manufacturing Group, LLC Reliant Manufacturing, Ltd. Reliant Metro Car6onation, LLC Reliant Processing Group, LLC Reliant Processing, Ltd. Reliant Supply Group, LLC Reliant Transportation Group, LLC Reliant Transportation, Ltd. Sandhill Group, LLC The Rice Family Irrevoca6le Trust Rice Partnership Re: 7301 Car6on Dioxide for Water Treatment Facility The ACORD name and logo are registered marks of ACORD