CTR063146 Certificate of Insurance FY24 Approved.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

7/25/2023

Gulfshore Insurance, Inc.

4100 Goodlette Road North Naples FL 34103-3303

Sierra Jasso 239-659-8869 239-213-2803 sijasso@gulfshoreinsurance.com

Imperium Insurance Company 35408

PARUS

Parkland (US) Holding Corp. and Parkland Corporation

PO BOX 1842

Minot ND 58703

59210371

A X

N

Y ECAP1IICWC00023901 3/31/2023 3/31/2024

1,000,000

1,000,000

1,000,000 A Stop Gap Coverage ECAP1IICWC00023901 3/31/2023 3/31/2024 Limit $1,000,000

Ohio, North Dakota & Wyoming

Workers Compensation includes Alternate Employer Endorsement

Additional Named Insureds:

Tropic Transportation, LLC Tropic Oil Company, LLC dba Tropic Fleet Services Superpumper Licensing Inc Superpumper Inc.

Superpumper Holdings Inc See Attached...

Arizona Department of Transportation 1739 W Jackson St Ste A Phoenix AZ 85007-3218

USA

a8812 Accepted

ACORD 101 (2008/01)

The ACORD name and logo are registered marks of ACORD

© 2008 ACORD CORPORATION. All rights reserved.

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:

ADDITIONAL REMARKS

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY CUSTOMER ID:

LOC #:

AGENCY

CARRIER NAIC CODE

POLICY NUMBER

NAMED INSURED

EFFECTIVE DATE:

PARUS

1 1

Gulfshore Insurance, Inc. Parkland (US) Holding Corp. and Parkland Corporation

PO BOX 1842

Minot ND 58703

25 CERTIFICATE OF LIABILITY INSURANCE

Story Distributing Company SPF Energy Inc Sevier Valley Oil Co., Inc Rhinehart Oil Co., Inc Rhinehart Acquisition Corp Parkland US LP Parkland US LP Parkland US Financing Corp Parkland US Acquisition Corp Parkland US 2LLC Parkland US 1 LLC Parkland PNW Holdings Corp Parkland Holding Corp.

Parkland Fuel Corporation dba Tropic Oil Company Parkland Corporation Parkland USA Corporation Parkland Canada (Holdings) ULC Parkland (U.S.) Supply Corp Parkland (U.S.) People Corp MVP US Holding Corp Missouri Valley Petroleum, Inc.

Lynch Oil Company Kellerstrass Equipment Leasing LLC Kellerstrass Enterprises, LLC J5 Transport Co Harts Gas & Food, LLC Farstad Oil, Inc.

Elbow River Marketing USA LTD Elbow River Marketing LTD Conrad & Bischoff LLC Carter Oil Co.

Bulk Solutions a8812 Highlight

1983 National Council on Compensation Insurance.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule.

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective Policy No. Endorsement No.

Insured Premium

Insurance Company Countersigned by ___________________________________________

WC 00 03 13

(Ed. 4-84)

Included

PARKLAND HOLDING CORP. AND PARKLAND CORPORATION

ECAP1-IIC-WC-000239-01

03-31-2023

Imperium Insurance Company

(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

Blanket

AS REQUIRED BY WRITTEN CONTRACT

Specific

Person or Organization Job Description