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HomeMy WebLinkAboutTRILLIUM TRANSPORTATION FUELS LLC - INSURANCE CERTIFICATE (2)CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I 11/16/2016 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: (A/C..NNo. Ext): (866) 283-7122 FAX No.): (800) 363-0105 E-MAIL ADDRESS: 5555 San Felipe suite 1500 Houston Tx 77056 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Ironshore Specialty Insurance Company 25445 Trillium Transportation Fuels, LLC INSURER B: ACE American Insurance Company 22667 PO BOX 26210 City Oklahoma City OK 73126 USA INSURERC: ACE Fire Underwriters Insurance Co. 20702 INSURERD: Indemnity Insurance Co of North America 43575 INSURER E: North American Elite Insurance Company 29700 INSURER F: COVERAGES CERTIFICATE NUMBER: 570073930055 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 INSR LTR TYPE OF INSURANCE AD INSD SUER WVD POLICY NUMBER LI Y EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY HDOG A 1 1 1 EACH OCCURRENCE $1 , 000 , 000 SIR applies per policy terns & condi ions DAMAGE RENTED $100,000 CLAIMS -MADE X❑ OCCUR PREMISES Ea occurrence MED EXP (Any one person) PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $8,000,000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $8,000,000 OTHER: B AUTOMOBILE LIABILITY ISA H25276310 12/01/2018 12/01/2019 COMBINED SINGLE LIMIT Ea accident $5,000,000 BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED Per accident ONLY AUTOS ONLY E X UMBRELLA LIAB OCCUR UMB200033104 12/01/2018 12/01/2019 EACH OCCURRENCE $10,000,000 HX SIR applies per policy terns & condi ions AGGREGATE $10,000,000 EXCESS LIAB CLAIMS-MADE DED I X RETENTION D WORKERS COMPENSATION AND WLRC65432286 12/01/2018 12/01/2019 PER 0 H- X STATUTE R B EMPLOYERS' LIABILITY Y/N WLRC65432328 12/01/2018 12/01/2019 E.L. EACH ACCIDENT $1 , 000 , 000 C ANY PROPRIETOR / PARTNER / EXECUTIVE N/A SCFC65432365 12/O1/2018 12/Ol/2019 OFFICER/MEMBEREXCLUDED'! (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 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) MCS90 and CA9948 are included on the above referenced Automobile Liability Policy. Certificate Holder is included as Additional Insured in 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. 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 Fort Collins AUTHORIZED REPRESENTATIVE PO Box 580 Fort Collins CO 80522 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD