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HomeMy WebLinkAboutTRILLIUM TRANSPORTATION FUELS LLC - INSURANCE CERTIFICATEAFRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/16/2016 I 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 Aon Risk Services Southwest, Inc. Houston TX Office CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-010S (A/C. No. Ext): (A/c. No.): E-MAIL ADDRESS: 5555 San Felipe Suite 1500 Houston TX 77056 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Ironshore specialty Insurance Company 25445 Trillium Transportation Fuels, LLC PO Box 26210 Oklahoma City OK 73126 USA INSURER B: ACE American Insurance Company 22667 INSURERC: ACE Fire Underwriters Insurance Co. 20702 INSURERD: Indemnity Insurance Co of North America 43575 INSURERE: North American Elite Insurance Company 29700 INSURER F: COVERAGES CERTIFICATE NUMBER: 570073930049 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 ADDL IN D WVD POLICY NUMBER MM/DD/YYYY MMlDD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y HDOG A 1 1 1177U'7= EACH OCCURRENCE $1, 000, 000 CLAIMS -MADE X❑ OCCUR SIR applies per policy terns & condl ions DAMAGE TO RENTED PREMISES Ea occurrence $100,000 MED EXP (Any one person) PERSONAL &ADV INJURY $1,000,000 GENIAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $8,00( 000 X POLICY ❑ PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $8,000,000 OTHER: B AUTOMOBILE LIABILITY Y Y ISA H25276310 12/01/2018 12/01/2019 COMBINED SINGLE LIMIT Ea accident g5,000,000 BODILY INJURY ( Per person) X ANYAUTO OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS PROPERTYDAMAGE HI REDAUTOS NON -OWNED ONLY AUTOS ONLY Per accident E X UMBRELLA LIAB X OCCUR UMB200033104 12/01/2018 12/01/2019 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE SIR applies per policy terns & conditions AGGREGATE $10,000,000 DED X RETENTION D WORKERS COMPENSATIONAND Y wLRC65432286 12/01/2018 12/01/2019 X TOTH STATUTE B Y/N Y WLRC65432328 12/01/2018 12/01/2019 E.L. EACH ACCIDENT $1 , 000 , 000 C ANY PROPRIETOR / PARTNER / EXECUTIVE N NIA Y SCFC65432365 12/01/2018 12/01/2019 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $1 , 000 , 000 If yes, dose, ibc under DESCRIPTION OF OPERATIONS below -- --- E.L. DISEASE -POLICY LIMIT $1 , 000 , 0OO A Env Site Liab 002S68601 12/01/2018 12/01/2021 Aggregate $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Bid No. 8496 Compressed Natural Gas Facility; MCS90 and CA9948 are included on the above referenced Automobile Liability The City, its included in policy. officers, agents and employees are as Additional Insured accordance with the policy provisions of the Auto Liability and General Liability policies. A waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the workers Compensation, Auto Liability and General Liability policies. Should the above described General Liability, Auto Liability, workers compensation and Umbrella Liability policies be cancelled before the expiration date thereof, the policy provisions will govern how notice of cancellation may be delivered to certificate holders in accordance with the policy provisions of each policy. CERTIFICATE HOLDER CANCELLATION d rn 0 0 0 rn 0 0 0 LO r` 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 Fort Collins AUTHORIZED REPRESENTATIVE PO BOX 580 Zi Fort Collins CO 80522 USA c�o�a a��:dOfc cJ�ssG�O c/cv�Lf�Jnct d ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD