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Home My WebLink AboutDERR-2024-004466PARLUST (1/17) Page 1 of 3 FINANCIAL RESPONSIBILITY - CERTIFICATE OF INSURANCE FEDERAL UNDERGROUND STORAGE TANK (UST) NAME AND ADDRESS (of each Covered Location): SEE ATTACHED SPREADSHEET POLICY NUMBER:PEC004100110 PERIOD OF COVERAGE: 5/01/23 - 5/01/24 NAME AND ADDRESS OF INSURER (herein called the “Insurer”): Indian Harbor Insurance Company Seaview House, 70 Seaview Avenue Stamford, CT 06902-6040 NAME AND ADDRESS OF INSURED (herein called the “Insured”): WALMART INC. 702 SOUTHWEST 8TH STREET BENTONVILLE, AR 72716-6299 1. Indian Harbor Insurance Company , the Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tanks(s): for taking corrective action and/or compensating third parties for bodily injury and property damage caused by either sudden accidental releases or non sudden accidental releases or accidental releases; in accordance with and subject to the limits of liability, exclusions, conditions, and other terms of the policy; arising from operating the underground storage tank(s) identified above. The limits of liability are $1,000,000 each occurrence and $2,000,000 annual aggregate, exclusive of legal defense costs, which are subject to a separate limit under the policy. This coverage is provided under PEC004100110. The effective date of said policy is 5/01/23. 2. The Insurer further certifies the following with respect to the insurance described in Paragraph 1: a. Bankruptcy or insolvency of the Insured shall not relieve the Insurer of its obligations under the policy to which this certificate applies. Number of Tanks Facility Name Facility Location SEE ATTACHED SPREADSHEET PARLUST (1/17) Page 2 of 3 b. The Insurer is liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or a damaged third-party, with a right of reimbursement by the Insured for any such payment made by the Insurer. This provision does not apply with respect to that amount of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280.102 and 40 CFR 280.104-280.107. c. Whenever requested by the Director of an implementing agency, the Insurer agrees to furnish to the Director a signed duplicate original of the policy and all endorsements. d. Cancellation or any other termination of the insurance by the Insurer, except for non- payment of premium or misrepresentation by the Insured, will be effective only upon written notice and only after the expiration of sixty (60) days after a copy of such written notice is received by the Insured. Cancellation for non-payment of premium or misrepresentation by the Insured will be effective only upon written notice and only after the expiration of a minimum of ten (10) days after a copy of such notice is received by the Insured. e. The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six (6) months of the effective date of cancellation or non-renewal of the policy except where the new or renewed policy has the same retroactive date or a retroactive date earlier than that of the prior policy, and which arise out of any covered occurrence that commenced after the policy retroactive date, if applicable, and prior to such policy renewal or termination date. Claims reported during such extended reporting period are subject to the terms, conditions, limits, including limits of liability, and exclusions of the policy. I hereby certify that the wording of this instrument is identical to the wording in 40 CFR 280.97(b)(2) and that the Insurer is licensed to transact the business of insurance, or eligible to provide insurance as an excess or surplus lines insurer, in one or more states. c/o AXA XL 505 Eagleview Boulevard Suite 100 Exton, PA 19341-0636 Date: 10/11/23 (Signature of Authorized Representative of Insurer) Joseph Madigan, Vice President Authorized Representative of: Indian Harbor Insurance Company PARLUST (1/17) Page 3 of 3 Facility #State ID Address City State ZIP UST 1440 8000201 1251 North Main St. Tooele UT 84074 2 1572 9000399 1851 W. Highway 40 Vernal UT 84078 2 1573 5000732 245 South Main Street Price UT 84501 2 1699 3000536 735 West Hill Field Road Layton UT 84041 2 1888 100725 1570 N. Main Street North Logan UT 84341 3 2511 TBD 949 West Grassland Dr. American Fork UT 84003 4 2921 1200676 534 N. Harrisville Rd. Harrisville UT 84404 3 3208 1000996 635 South 1950 West Springville UT 84663 3 3454 100721 1120 S. Commerce Way Brigham City UT 84302 4 3568 4002548 3180 S. 5600 W West Valley City UT 84120 2 3620 TBD 3823 W. 13400 S. Riverton UT 84065 3 3988 1000942 898 S 2550 E Spanish Fork UT 84660 3 4272 TBD 1152 South 100 West Logan UT 84321 3 4696 TBD TBD Heber City UT 3 4718 4002407 11278 South Jordan Gtwy South Jordan UT 84095 4 4730 4002298 7607 S. Campus View West Jordan UT 84084 3 4786 0100638 1275 N. Main Logan UT 84321 3 5109 4002330 4570 S. 4000 West West Valley City UT 84120 3 5167 TBD TBD Payson UT 3 5206 1200677 1710 E. Skyline Dr. Ogden UT 84405 3 5233 4002657 5675 W. 6200 S. Kearns UT 84118 3 5235 TBD 9151 S. Quarry Bend Drive Sandy UT 84094 4 5763 4002666 3590 W. South Jordan Pkwy South Jordan UT 84095 3 5270 1000995 585 N. State Street Lindon UT 84042 3 6683 4002352 6525 South State St. Murray UT 84107 3 6684 1200586 4945 South 900 West St. Ogden UT 84405 3 6685 1000810 1313 University Ave. Provo UT 84601 3 6686 4000263 1905 S. 3000 West Salt Lake City UT 84119 3 7026 8000177 965 Highway 138 Grantsville UT 84029 4 7168 4002671 13352 S Fort Herriman Pkwy Herriman UT 84096 3