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HomeMy WebLinkAboutTRILLIUM TRANSPORTATION FUELS LLC - INSURANCE CERTIFICATE (4)CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) lvzvzol7 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) 363-0105 (AIC. No. Ext): (AIC. No.): E-MAIL ADDRESS: 5555 San Felipe Suite 1S00 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: Indemnity Insurance Co of North America 43575 INSURER D: Agri General Insurance Company 42757 INSURERE: ACE Fire Underwriters Insurance Co. 20702 INSURERF: North American Elite insurance Company 129700 COVERAGES CERTIFICATE NUMBER: 570069282439 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 ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DID/YYYY MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y XSLG EACH OCCURRENCE $1,000,000 CLAIMS X❑ OCCUR SIR applies per policy terns & condl lOns AMA RENTED $100,000 -MADE PREMISES Ea occurrence MED EXP (Any one person) PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $8,000,000 X POLICY ❑ PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $8,000,000 OTHER: B AUTOMOBILE LIABILITY Y Y ISA H25098158 12/01/2017 12/01/2018 COMBINED SINGLE LIMIT Ea accident $5,000,000 BODILY INJURY ( Per person) X ANYAUTO OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS PROPERTY DAMAGE HIREDAUTOS NON -OWNED ONLY AUTOS ONLY Per accident F X UMBRELLA LIAB X OCCUR UMB200033103 12/01/2017 12/01/2018 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE SIR applies per policy terns & conditions AGGREGATE $10,000,000 DED X RETENTION C WORKERS COMPENSATION AND Y WLRC64623266 12/01/2017 12/01/2018 X PER OTH- STATUTE ER B EMPLOYERS' LIABILITY YIN Y WLRC64623278 12/01/2017 12/01/2018 E.L. EACH ACCIDENT $1,000,000 D ANY PROPRIETOR / PARTNER / EXECUTIVE NIA Y wLRc64623291 12/01/2017 12/01/2018 E OFFICER/MEMBEREXCLUDED? (Mandatory in NH) Y SCFc6462328A 12/01/2017 12/01/2018 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 [_0 02568600 v 02/29/2016 12/01/2018 Aggregate __ $10",000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 policy. The City, its officers, agents and employees are 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. 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 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 `m c d d a 0 2 M 61 v 00 LO 0 0 I- Lo ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD