CTR063146 Certificate of Insurance FY25 Approved.pdf
PDF 419 KB Posted
- Attached to
- Master Agreement AZ|CTR063146
- Contract number
- CTR063146
- Issued by
- Arizona
About this file
This document is a Certificate of Liability Insurance issued by Aon Risk Services Central, Inc. for Parkland (U.S.) Holding Corp., with multiple insurance policies underwritten by various insurers including Zurich American Insurance Company, American Zurich Insurance Company, ACE American Insurance Company, and Zurich Insurance Company Ltd. The certificate is dated May 30, 2024, and names the Arizona Department of Transportation as the certificate holder. The policies provide coverage for commercial general liability, automobile liability, excess liability, and workers' compensation with effective dates from February 1, 2024 to June 1, 2025.
The insurance policies offer comprehensive coverage with significant liability limits, including $7,500,000 for commercial general liability, $5,000,000 for automobile liability, and $5,000,000 for umbrella liability. The policies cover multiple entities including Parkland USA Corporation, Elbow River Marketing USA Ltd, and various subsidiaries doing business under names such as Farstad Oil, SPF Energy, Conrad & Bischoff, and Rhinehart Oil. The coverage includes provisions for additional insured status, primary and non-contributory insurance, and waivers of subrogation. The policies are specifically designed to meet transportation and motor carrier insurance requirements, with endorsements complying with Federal Motor Carrier Safety Administration (FMCSA) regulations.
View the file
Other files
Show all 29
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
D H o ld e r
Id e n ti fi e r
77777 77707 07070 00777 61616 04557 11107 67535 23602 64450 07763 11474 06241 33071 66374 60562 33110 74060 45772 76556 20717 23335 73032 66107 63741 06220 33702 07104 11357 63345 70076 35130 44114 77020 76727 24203 57720 00777 77770 70007 07007
77777 77707 07070 00735 25677 11545 60007 73554 01653 70120 07026 73770 20621 01070 26633 75253 20110 74226 73316 53245 10742 73772 02576 11007 46237 23060 22555 07023 72364 20771 00071 22336 34206 31110 77756 16335 17655 40777 77770 70007 07007
C e rt if ic a te
N o
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
05/30/2024
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.
PRODUCER
Aon Risk Services Central, Inc.
Minneapolis MN Office 5600 West 83rd Street 8200 Tower, Suite 1100 Minneapolis MN 55437 USA
PHONE
(A/C. No. Ext):
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
(866) 283-7122
INSURED 16535Zurich American Ins CoINSURER A:
40142American Zurich Ins CoINSURER B:
22667ACE American Insurance CompanyINSURER C:
AA1460190Zurich Insurance Company LtdINSURER D:
INSURER E:
INSURER F:
FAX
(A/C. No.):
(800) 363-0105
CONTACT
NAME:
Parkland (U.S.) Holding Corp.
PO Box 1842 100 NE 27th St Minot ND 58702 USA
COVERAGES CERTIFICATE NUMBER: 570105941723 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
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
(MM/DD/YYYY)
SUBR
WVD
INSR
LTR
ADDL
INSD POLICY NUMBER TYPE OF INSURANCE LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
POLICY LOC
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
X
X
X
X
GEN'L AGGREGATE LIMIT APPLIES PER:
$7,500,000
$300,000
$5,000
$7,500,000
$7,500,000
$7,500,000
Sudden & Accidental Pollution Included
A 06/01/2024 06/01/2025Y Y GLO484649901
PRO-
JECT
OTHER:
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED AUTOS
ONLY
NON-OWNED
AUTOS ONLY
BODILY INJURY ( Per person)
PROPERTY DAMAGE
(Per accident)
X
BODILY INJURY (Per accident)
$5,000,000C 06/01/2024 06/01/2025Y Y COMBINED SINGLE LIMIT
(Ea accident)
H25124194
EXCESS LIAB
X OCCUR
CLAIMS-MADE AGGREGATE
EACH OCCURRENCE
DED
$5,000,000
$5,000,000
06/01/2024
SIR applies per policy terms & conditions
UMBRELLA LIABD Y 06/01/2025Y CSINT2400766
RETENTIONX
X
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
E.L. EACH ACCIDENT $1,000,000
X OTH-
ER
PER STATUTEB 02/01/2024 02/01/2025
AOS
WC665797700A 02/01/2024 02/01/2025
$1,000,000
Y / N
(Mandatory in NH)
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED? N / A
Y
YN
WI
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
If yes, describe under DESCRIPTION OF OPERATIONS below
$1,000,000
WC665797600
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Arizona Department of Transportation is included as additional insured with respect to General Liability, Automobile Liability, and Excess Liability policies. General Liability, Automobile Liability and Excess Liability policies, evidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. Cross Liability/Severability of Interests Language, Contractual Liability and coverage for independent contractors are included under the General Liability policies.
CANCELLATIONCERTIFICATE HOLDER
AUTHORIZED REPRESENTATIVEArizona Department of Transportation 1739 W Jackson St Ste A Phoenix AZ 85007-3218 USA
ACORD 25 (2016/03)
©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
G0171 Accepted
Additional Policy Provisions
AGENCY CUSTOMER ID:
ADDITIONAL REMARKS SCHEDULE
LOC #:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance
EFFECTIVE DATE:
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSUREDAGENCY
See Certificate Number:
See Certificate Number:
Aon Risk Services Central, Inc.
570000069504
570105941723
570105941723
Page _ of _
Parkland (U.S.) Holding Corp.
A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of General Liability, Automobile Liability, Workers Compensation, Employers Liability and Excess Liability policies.Garage Liability is included in the Automobile Liability policy. Excess Automobile Liability policies is a follow form to the Primary US Automobile (USD 5M). As respects policy number CSINT2400766 Excess Liability, Aon Risk Solutions (US) is generating and distributing this certificate in an administrative capacity. Aon UK Limited is the broker for the defined policy. Excess Liability policy is Follow form over General/ Liability, Workers' Compensation/Employer's Liability/Monopolistic Stop Gap policies. MCS-90 is issued at USD 5,000,000 limit thru Ace American Insurance Company.
Named Insured Addendum
Parkland USA Corporation Parkland Corporation Parkland (U.S.) Holding Corp.
Elbow River Marketing USA Ltd.
Parkland (US) Supply Corp Parkland (US) Financing Corp Parkland (US) People Corp Tropic Acquisition Corp Tropic Oil Company LLC Tropic Transportation LLC DBA SPF Energy DBA Missouri Valley Petroleum (MVP) DBA J5 Transport DBA Farstad Oil DBA Conrad & Bischoff DBA H&H Sub DBA Yeates DBA Jackson Liquors DBA Harts Gas and Food DBA Rhinehart Acquisition DBA Rhinehart Oil DBA Kellerstrass Leasing DBA Kellerstrass Enterprises DBA Parkland PNW Holdings DBA Superpumper DBA Bulk Solutions
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
G0171 Highlight
G0171 Highlight
Excess Automobile Liability Layers
AGENCY CUSTOMER ID:
ADDITIONAL REMARKS SCHEDULE
LOC #:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance
EFFECTIVE DATE:
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSUREDAGENCY
See Certificate Number:
See Certificate Number:
Aon Risk Services Central, Inc.
570000069504
570105941723
570105941723
Page _ of _
Parkland (U.S.) Holding Corp.
1st Layer Excess Automobile Liability AXIS Surplus Insurance Company Policy # P00100039579305
$2,000,000 XS $5,000,000
Effective Date: 06/1/2024- Expiration Date: 06/1/2025
2nd Layer Excess Automobile Liability Endurance American Specialty Insurance Company Policy # EXT30038467601
$2,000,000 XS $7,000,000
Effective Date: 06/01/2024- Expiration Date: 06/01/2025
3rd Layer Excess Automobile Liability AXIS Surplus Insurance Company Policy # P00100384794101
$1,000,000 XS $9,000,000
Effective Date: 06/01/2024- Expiration Date: 06/01/2025
ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMERCIAL AUTO
CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 04 44 10 13 Insurance Services Office, Inc., 2011 Page 1 of 1
Named Insured: Parkland US Holding Corp and subsidiaries
Name(s) Of Person(s) Or Organization(s):
ANY PERSON OR ORGANIZATION FOR WHOM THE INSURED IS REQUIRED TO
WAIVE RIGHT TO RECOVERY UNDER A CONTRACT AS DESCRIBED BELOW.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
SCHEDULE
The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the ‘‘accident’’ or the ‘ loss’’ under a contract with that person or organization.
CA 20 48 10 13 Insurance Services Office, Inc., 2011 Page 1 of 1
Named Insured: Parkland US Holding Corp and subsidiaries
Name Of Person(s) Or Organization(s):
ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO ADD AS AN
ADDITIONAL INSURED TO
AGREEMENT UNLESS SUCH
A. IS EXECUTED AFTER THE
B. INVOLVES THE OWNER OR
THIS POLICY
CONTRACT OR
DATE OF THE
ANYONE ELSE
BORROW A COVERED "AUTO" UNLESS IT IS
"AUTO" YOU OWN.
BY WRITTEN CONTRACT OR
AGREEMENT:
LOSS OR
FROM WHOM YOU HIRE OR
A "TRAILER" CONNECTED TO COVERED
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
CA 20 48 10 13
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are ‘‘insureds’’ for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Each person or organization shown in the Schedule is an ‘‘insured’’ for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an ‘‘insured’’ under the Who Is An Insured provision contained in Paragraph A.1. of Section II ---- Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I ---- Covered Autos Coverages of the Auto Dealers Coverage Form.
CA 99 48 10 13
CA 99 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1
POLLUTION LIABILITY - BROADENED COVERAGE
FOR COVERED AUTOS - BUSINESS AUTO AND
MOTOR CARRIER COVERAGE FORMS
This endorsement modifies insurance provided under the following:
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
A. Covered Autos Liability Coverage is changed as follows:
1. Paragraph a. of the Pollution Exclusion applies only to liability assumed under a contract or agreement.
2. With respect to the coverage afforded by Paragraph A.1. above, Exclusion B.6. Care, Custody Or Control does not apply.
B. C anges In Definitions For the purposes of this endorsement, Paragraph D. of the Definitions Section is replaced by the following:
D. "Covered pollution cost or expense" means any cost or expense arising out of:
1. Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or
2. Any claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to or assessing the effects of "pollutants".
"Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants":
a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto"; or
b. After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured".
Paragraphs a. and b. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if:
(1) The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and
(2) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage.
IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
POLICY NUMBER: MCC H25124194 IL 00 17 11 98
COMMON POLICY CONDITIONS
All Coverage Parts included in this policy are subject to the following conditions.
A. Cancellation
1. The first Named Insured shown in the Declara-tions may cancel this policy by mailing or de-livering to us advance written notice of cancel-lation.
2. We may cancel this policy by mailing or deliv-ering to the first Named Insured written notice of cancellation at least:
a. 10 days before the effective date of cancel-lation if we cancel for nonpayment of pre-mium; or
b. 30 days before the effective date of cancel-lation if we cancel for any other reason.
3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us.
4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date.
5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be ef-fective even if we have not made or offered a refund.
6. If notice is mailed, proof of mailing will be suf-ficient proof of notice.
B. Changes This policy contains all the agreements between you and us concerning the insurance afforded.
The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy.
C. Examination Of Your Books And Records We may examine and audit your books and rec-ords as they relate to this policy at any time during the policy period and up to three years afterward.
D. Inspections And Surveys
1. We have the right to:
a. Make inspections and surveys at any time;
b. Give you reports on the conditions we find;
and
c. Recommend changes.
2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in-surability and the premiums to be charged. We do not make safety inspections. We do not un-dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions:
a. Are safe or healthful; or
b. Comply with laws, regulations, codes or standards.
3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations.
4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or recom-mendations we may make relative to certifica-tion, under state or municipal statutes, ordi-nances or regulations, of boilers, pressure ves-sels or elevators.
E. Premiums The first Named Insured shown in the Declara-tions:
1. Is responsible for the payment of all premiums;
and
2. Will be the payee for any return premiums we pay.
F. Transfer Of Your Rights And Duties Under This
Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured.
If you die, your rights and duties will be trans-ferred to your legal representative but only while acting within the scope of duties as your legal rep-resentative. Until your legal representative is ap-pointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property.
COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Wolters Kluwer Financial Services | Uniform FormsTM
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
Name Of Additional Insured Person(s) Or Organization(s)
Location And Description Of Completed Operations
AS REQUIRED BY WRITTEN CONTRACT AS REQUIRED BY WRITTEN CONTRACT
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard".
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1
UNIFORM
ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
Name Of Additional Insured Person(s) Or Organization(s)
Any person or organization to who or to which you are required to provide additional insured status in a Written contract or written agreement executed prior to loss, except where such contract or agreement Prohibited by law.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II – Who Is An Insured is amended to in-clude as an additional insured the person(s) or or-ganization(s) shown in the Schedule, but only with re-spect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you.
CG 24 17 10 01
CG 24 17 10 01 © ISO Properties, Inc., 2000 Page 1 of 1
CONTRACTUAL LIABILITY – RAILROADS
Scheduled Railroad: Designated Job Site:
All contracts for work done for railroads, as required by written contract
All contracts for work done for railroads, as required by written contract
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
With respect to operations performed for, or affecting, a Scheduled Railroad at a Designated Job Site, the definition of "insured contract" in the Definitions sec-tion is replaced by the following:
9. "Insured Contract" means:
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or or-ganization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract";
b. A sidetrack agreement;
c. Any easement or license agreement;
d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agreement pertaining to your business (including an in-demnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization.
Tort liability means a liability that would be imposed by law in the absence of any con-tract or agreement.
Paragraph f. does not include that part of any contract or agreement:
(1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of:
(a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or draw-ings and specifications; or
(b) Giving directions or instructions, or failing to give them, if that is the pri-mary cause of the injury or damage;
(2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in Paragraph (1) above and super-visory, inspection, architectural or engi-neering activities.
U-GL-1521-B CW (01/19)
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
INTERNAL USE ONLY
Blanket Notification to Others of Cancellation or Non-Renewal
This endorsement applies to insurance provided under the:
Commercial General Liability Coverage Part
A. If we cancel or non-renew this Coverage Part by written notice to the first Named Insured, we will mail or deliver notification that such Coverage Part has been cancelled or non-renewed to each person or organization shown in a list provided to us by the first Named Insured if you are required by written contact or written agreement to provide such notification. Such list:
1. Must be provided to us prior to cancellation or non-renewal;
2. Must contain the names and addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled or non-renewed; and
3. Must be in an electronic format that is acceptable to us.
B. Our notification as described in Paragraph A. of this endorsement will be based on the most recent list in our records as of the date the notice of cancellation or non-renewal is mailed or delivered to the first Named Insured. We will mail or deliver such notification to each person or organization shown in the list:
1. Within 10 days of the effective date of the notice of cancellation, if we cancel for non-payment of premium; or
2. At least 30 days prior to the effective date of:
a. Cancellation, if cancelled for any reason other than nonpayment of premium; or
b. Non-renewal, but not including conditional notice of renewal, unless a greater number of days is shown in the Schedule of this endorsement for the mailing or delivering of such notification with respect to Paragraph B.1. or Paragraph B.2. above.
C. Our mailing or delivery of notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy only. Our failure to provide such mailing or delivery will not:
1. Extend the Coverage Part cancellation or non-renewal date;
2. Negate the cancellation or non-renewal; or
3. Provide any additional insurance that would not have been provided in the absence of this endorsement.
U-GL-1521-B CW (01/19)
INTERNAL USE ONLY
D. We are not responsible for the accuracy, integrity, timeliness and validity of information contained in the list provided to us as described in Paragraphs A. and B. of this endorsement.
The total number of days for mailing or delivering with respect to Paragraph B.1. of this endorsement is amended to indicate the following number of days: *
The total number of days for mailing or delivering with respect to Paragraph B.2. of this endorsement is amended to indicate the following number of days: **
* If a number is not shown here, 10 days continues to apply.
** If a number is not shown here, 30 days continues to apply.
All other terms and conditions of this policy remain unchanged.
Other Insurance Amendment – Primary And Non-
U-GL-1327-B CW (04/13)
Contributory
Named Insured: Parkland Corporation Address (including ZIP Code):
100 NE 27th St. Minot, ND 58702
This endorsement modifies insurance provided under the:
1. The following paragraph is added to the Other Insurance Condition of Section IV – Commercial General Liability Conditions:
This insurance is primary insurance to and will not seek contribution from any other insurance available to an additional insured under this policy provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV – Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis.
All other terms and conditions of this policy remain unchanged.
Waiver Of Subrogation (Blanket) Endorsement
U-GL-925-B CW (12/01)
This endorsement modifies insurance provided under the:
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from oth-ers, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to any other operations in which the insured has no contractual interest.
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 applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN
CONTRACT, OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE
ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS
POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION
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 02-01-24 Policy No. WC 6657976-00 Endorsement No.
Insured PARKLAND US HOLDINGS 2024 FINA Premium $ INCL.
Insurance Company AMERICAN ZURICH INSURANCE COMPANY
Countersigned By
WC 00 03 13
(Ed. 4-84) 1983 National Council on Compensation Insurance.
AUTOMATIC ADDITIONAL INSURED ENDORSEMENT
Named Insured Parkland (US) Holding Corporation
Policy Symbol
MCC
Policy Number H25124194
Policy Period
06/01/2024 TO 06/01/2025
Issued By (Name of Insurance Company) ACE American Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
SECTION II - LIABILITY COVERAGE, WHO IS AN INSURED is amended to include as an "insured" any person or organization you are required in a written contract or agreement to name as an Additional Insured on your policy but only for "bodily injury" or "property damage" to which this insurance applies if the "accident" is caused by:
1. You, while using a covered “auto” or
2. Any other person, while using a covered “auto” with your permission.
The insurance provided by this endorsement shall be subject to the following additional condition:
1. The Limit of Insurance provided for the Additional Insured shall not be greater than those required by contract and, in no event, shall the policy Limits of Insurance be increased by the contract.
2, All insuring agreements, exclusions, terms and conditions of the policy shall apply to the coverage (s) provided to the Additional Insured, and such coverage shall not be enlarged or expanded by reason of the contract.
3. Coverage provided by this endorsement shall be excess over any other valid and collectible insurance available to the Additional Insured (s) whether primary, excess, contingent or on any other basis unless the contract specifically requires that this insurance be primary or you request that it apply on a primary basis prior to loss.
DA-6Z04a (06/14) Page 1 of 1
FORM MCS-90 OMB No.: 2126-0008 Expiration: 06/01/2025
USDOT Number: Date Received:
FORM MCS-90 Page 1 of 4 Rev 6/3/2021 MC1622y (06-21) Wolters Kluwer | Uniform Forms
United States Department of Transportation Federal Motor Carrier Safety Administration
Please note, the expiration date as stated on this form relates to the process for renewing the Information Collection Request for this form with the Office of Management and Budget. This requirement to collect information as requested on this form does not expire.
For questions, please contact the Office of Registration and Safety Information, Registration, Licensing, and Insurance Division.
A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection of information is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590.
Endorsement for Motor Carrier Policies of Insurance for Public Liability under Sections 29 and 30 of the Motor Carrier Act of 1980
FORM MCS-90
Issued to Parkland US Holding Corp.,Elbow River Marketing USA Ltd;
Parkland USA Corporation DBA as Farstad Oil, Parkland USA Corporation DBA as SPF Energy, Parkland USA Corporation DBA as Conrad & Bischoff, Parkland USA Corporation DBA as Rhinehart Oil Parkland USA Corporation DBA Superpumper of North Dakota
(Motor Carrier name) (Motor Carrier state or province)
Dated at Philadelphia, PA on this 1st day of June, 2024
Amending Policy Number: H25124194 Effective Date: 06/01/2024
Name of Insurance Company: ACE American Insurance Co
Countersigned by:
(authorized company representative)
The policy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown (check only one):
This insurance is primary and the company shall not be liable for amounts in excess of $5,000,000 for each accident.
This insurance is excess and the company shall not be liable for amounts in excess of $ for each accident in excess of the underlying limit of $ for each accident.
Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA,to verify that the policy is in force as of a particular date. The telephone number to call is: 215-640-4555 .
Cancellation of this endorsement may be effected by the company or the insured by giving (1) thirty-five (35) days notice in writing to the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and (2) if the insured is subject to the FMCSA’s registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, DC).
Filings must be transmitted online via the Internet at http://www.fmcsa.dot.gov/urs.
http://www.fmcsa.dot.gov/urs
USDOT Number: Date Received:
Filings must be transmitted online via the Internet at http://www.fmcsa.dot.gov/urs.
Please note, the expiration date as stated on this form relates to the process for renewing the Information Collection Request for this form with the Office of Management and Budget. This requirement to collect information as requested on this form does not expire.
For questions, please contact the Office of Registration and Safety Information, Registration, Licensing, and Insurance Division.
A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection of information is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal
FORM MCS-90
Issued to Parkland USA Corporation DBA Rhinehart Oil of Utah
(Motor Carrier name) (Motor Carrier state or
Dated at Philadelphia, PA on this 1st province) day of June, 2024
The policy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown (check only one):
This insurance is primary and the company shall not be liable for amounts in excess of $5,000,000 for each accident.
This insurance is excess and the company shall not be liable for amounts in excess of $ for each accident in excess of the underlying limit of $ for each accident.
Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA,to verify that the policy is in force as of a particular date. The telephone number to call is: 215-640-4555 .
Cancellation of this endorsement may be effected by the company or the insured by giving (1) thirty-five (35) days notice in writing to the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and (2) if the insured is subject to the FMCSA’s registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, DC).
Filings must be transmitted online via the Internet at http://www.fmcsa.dot.gov/urs.
Please note, the expiration date as stated on this form relates to the process for renewing the Information Collection Request for this form with the Office of Management and Budget. This requirement to collect information as requested on this form does not expire.
For questions, please contact the Office of Registration and Safety Information, Registration, Licensing, and Insurance Division.
A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection of information is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal
FORM MCS-90
Issued to Tropic Oil Company, LLC of FL
(Motor Carrier name) (Motor Carrier state or province)
Dated at Philadelphia, PA on this 1st day of June, 2024
The policy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown (check only one):
This insurance is primary and the company shall not be liable for amounts in excess of $5,000,000 for each accident.
This insurance is excess and the company shall not be liable for amounts in excess of $ for each accident in excess of the underlying limit of $ for each accident.
Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA,to verify that the policy is in force as of a particular date. The telephone number to call is: 215-640-4555 .
Cancellation of this endorsement may be effected by the company or the insured by giving (1) thirty-five (35) days notice in writing to the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and (2) if the insured is subject to the FMCSA’s registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, DC).
USDOT Number: 861294 Date Received:
FORM MCS-90 Page 3 of 4 MC1622y (06-21)
Accident includes continuous or repeated exposure to conditions or which results in bodily injury, property damage, or environmental damage which the insured neither expected nor intended.
Motor Vehicle means a land vehicle, machine, truck, tractor, trailer, or semitrailer propelled or drawn by mechanical power and used on a highway for transporting property, or any combination thereof.
Bodily Injury means injury to the body, sickness, or disease to any person, including death resulting from any of these.
Property Damage means damage to or loss of use of tangible property.
Environmental Restoration means restitution for the loss, damage, or destruction of natural resources arising out of the accidental discharge, dispersal, release or escape into or upon the land, atmosphere, watercourse, or body of water, of any commodity transported by a motor carrier. This shall include the cost of removal and the cost of necessary measures taken to minimize or mitigate damage to human health, the natural environment, fish, shellfish, and wildlife.
Public Liability means liability for bodily injury, property damage, and environmental restoration.
The insurance policy to which this endorsement is attached provides automobile liability insurance and is amended to assure compliance by the insured, within the limits stated herein, as a motor carrier of property, with Sections 29 and 30 of the Motor Carrier Act of 1980 and the rules and regulations of the Federal Motor Carrier Safety Administration (FMCSA).
In consideration of the premium stated in the policy to which this endorsement is attached, the insurer (the company) agrees to pay, within the limits of liability described herein, any final judgment recovered against the insured for public liability resulting from negligence in the operation, maintenance or use of motor vehicles subject to the financial responsibility requirements of Sections 29 and 30 of the Motor Carrier Act of 1980 regardless of whether or not each motor vehicle is specifically described in the policy and whether or not such negligence occurs on any route or in any territory authorized to be served by the insured or elsewhere.
Such insurance as is afforded, for public liability, does not apply to injury to or death of the insured’s employees while engaged in the course of their employment, or property transported by the insured, designated as cargo. It is understood and agreed that no condition, provision, stipulation, or limitation contained in the policy, this endorsement, or any other endorsement thereon, or violation thereof, shall relieve the company from liability or from the payment of any final judgment, within the limits of liability herein described, irrespective of the financial condition, insolvency or bankruptcy of the insured. However, all terms, conditions, and limitations in the policy to which the endorsement is attached shall remain in full force and effect as binding between the insured and the company. The insured agrees to reimburse the company for any payment made by the company on account of any accident, claim, or suit involving a breach of the terms of the policy, and for any payment that the company would not have been obligated to make under the provisions of the policy except for the agreement contained in this endorsement.
It is further understood and agreed that, upon failure of the company to pay any final judgment recovered against the insured as provided herein, the judgment creditor may maintain an action in any court of competent jurisdiction against the company to compel such payment.
The limits of the company’s liability for the amounts prescribed in this endorsement apply separately to each accident and any payment under the policy because of anyone accident shall not operate to reduce the liability of the company for the payment of final judgments resulting from any other accident.
(continued on next page)
DEFINITIONS AS USED IN THIS ENDORSEMENT
Form MCS-90 (4/2000) MC 1622p (01-07)
Type of carriage Commodity transported January 1, 1985
(1) For-hire (in interstate or foreign commerce, with a gross vehicle weight rating of 10,001 or more pounds).
Property (nonhazardous) $750,000
(2) For-hire and Private (in interstate, foreign, or intrastate commerce, with a gross vehicle weight rating of 10,001 or more pounds).
(3) For-hire and Private (in interstate or foreign commerce, in any quantity; or in intrastate commerce, in bulk only; with a gross vehicle weight rating of 10,001 or more pounds).
(4) For-hire and Private (In interstate or foreign commerce, with a gross vehicle weight rating of less than 10,001 pounds).
Hazardous substances, as defined in 49 CFR 171.8, transported in cargo tanks, portable tanks, or hopper-type vehicles with capacities in excess of 3,500 water gallons; or in bulk Division 1.1, 1.2, and 1.3 materials, Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; in bulk Division 2.1 or 2.2; or highway route controlled quantities of a Class 7 material, as defined in 49 CFR 173.403.
Oil listed in 49 CFR 172.101; hazardous waste, hazardous materials, and hazardous substances defined in 49 CFR 171.8 and listed in 49 CFR 172.101, but not mentioned in (2) above or (4) below.
Any quantity of Division 1.1, 1.2, or 1.3 material; any quantity of a Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; or highway route controlled quantities of a Class 7 material as defined in 49 CFR 173.403.
$5,000,000
$1,000,000
$5,000,000
*The schedule of limits shown does not provide coverage. The limits shown in the schedule are for information purposes only.
SCHEDULE OF LIMITS — PUBLIC LIABILITY
| job010JMTKHVTHHK1ECB9A316E.dat |
| WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) |
| SCHEDULE |
| COMMERCIAL AUTO |
| DESIGNATED INSURED FOR |
| SCHEDULE |
| POLLUTION LIABILITY - BROADENED COVERAGE FOR COVERED AUTOS - BUSINESS AUTO AND MOTOR CARRIER COVERAGE FORMS |
| B. C anges In Definitions |
| COMMON POLICY CONDITIONS |
| A. Cancellation |
| B. Changes |
| C. Examination Of Your Books And Records |
| D. Inspections And Surveys |
| E. Premiums |
| F. Transfer Of Your Rights And Duties Under This Policy |
| ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS |
| SCHEDULE |
| ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION |
| SCHEDULE |
| CONTRACTUAL LIABILITY – RAILROADS |
| SCHEDULE |
| Blanket Notification to Others of Cancellation or Non-Renewal |
| Commercial General Liability Coverage Part |
| Contributory |
| THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. |
| Address (including ZIP Code): |
| Commercial General Liability Coverage Part |
| THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. |
| Commercial General Liability Coverage Part |
| WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 |
| WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT |
| BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM |
| FORM MCS-90 |
| FORM MCS-90 |
| FORM MCS-90 |
File details come from the government source that posted it. Updated .