DERR-2024-006235

CERTIFICATE OF LIABILIry INSURANCE DATE (MM/DD/YYYY)
3t26t2024
THIS CERTIFICATE IS ISSUED AS A MAfiER 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 TNSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSUTNG TNSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have AODITIONAL INSURED provisions or be endorsed.
lf SUBROGATION lS WAIVED, subject to the terms and conditions of the pollcy, certain policies may require an endorsement. A statement on
this certlficate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
Higginbotham lnsurance Agency, lnc.
500 W. 13th Street
FtWorth fX76102
Janna Certificate
8',t7-345-2384
AFFORDING COVERAGE
rNsuRER A : National lnterstate lnsurance Co.32620
INSURED
Big Star Transportation, LLC
dba Big Star Crude Co. LLC
13182 N. MacArthur Blvd.
Oklahoma CitV OK73142
STARTRA.O4 rNsuRER B , Oxford lnsurance Comoanv NC LLC 16817
lNsuRER c ' Westchester Surolus Lines lns Co 10172
rNsuRER D , Benchmark SDecialtv lnsurance Comoanv 17180
tNsuRER E ' Greal American lnsurance comoanv 16691
INSTjRER F :
COVERAGES TE NUMBER:640413606 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.
INSRtTo TYPE OF INSURANCE POLICY NIITIBER LIMITS
EACH OCCURRENCE $ 1.000.000
!
P $ 5,000
MED EXP (Anv one osrson)$ 50,000
PERSONAL & ADV INJURY $ 100,000
GENERAL AGGREGATE $ 2.000.000
PRODUCTS. COMP/OP AGG $ 1.000.000
COMMERCIAL GENERAL LIABILITY
X
GEN't AGGREGATE LIMIT APPLIES PER:
'o,-'""f l5ffi Il
X
X
X LOC
OCCUR
Ded $150,000
CLAIMS-MADE
sTR 8199971 04 3t30t2024 3t30t2025
!
$ 1,000,000
BODILY INJURY (P€r pereon)$
BODILY INJURY (Per accident)
$
AUTOMOBILE LIABILITY
AUTOS ONLY
X
SCHEDULEDOWNED
AUTOS AUTOS
NON-OWNEDHIRED
AUTOSX
X
X
X
ANY AUTO
ONLY
ONLY
sTR 8'199971 04 3t30t2024 3t30t2025
X EACH OCCURRENCE $ 5.000.000
X
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS-MADE AGGREGATE $ 5.000.000
B
DFD FIFTFNTI6N g
oRMSI-1-24-NC 3t30t2024 3t30t2025
$
X PEK
QTATI ITF UIH-FR
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETORYPARTNEFVEXECUTIVE
OFFICER/MEMBEREXCLUDED?
(Mandatory ln NH)
lf yes, describe under
DESCRIPTION OF OPERATIONS below
N
Y/N
N/A
wc1475413-13 313012024 3t30t2025
E.L- DISEASE - POLICY LIMIT s '1.000.000
D
Pollution Liability
Exc6ss Pollution Liability
G71799281 005
MNGR-X-20004s2-01
313012024
313012024
313012025
313012025
Limit:
Limit:
$5,000,000
$1,000,000
DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES (ACORDl0l,AddilionalRomarksSchodulo,maybeattachedifmorospaceisr6quirod)
INSURER AFFORDING COVERAGE: XL Specially lnsurance Companv NAIC#: 37885
POLICY NUMBER: UM00033559MA24A EFF DAfE: 03/30/2024EXp bRte: Ogl3olZOZS
TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
Motor Truck Cargo Per Truck Limit $50,000
Coverage is for non-owned trailers not in possession for over 30 days at 975,000.
ryPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT:
See Attached...
CERTIFICATE HOLDER CANCELLATION
PROOF OF INSURANCE
''NOT TO BE ALTERED'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE I'VITH THE POLICY PROVISIONS.
AUTHORIZED
@ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
PNOoucT CONTAINMENT INTEGRTY RCPORT
PeraoEwwno
Site Name:AL(FID Number:
Test Date:o4 )zSite Address:71Ls s Ll D{ trz 4\o.AeSA/c uL t 4Ozl
Llne Location Product Worklno PSI Tvoe Rate Results
1 \/
2 \/
3
4
5 /\
6
ResultsLlneLocationProductMakeModelRate
1 \
2 \/
3
4
5 ,/\
6
Llouid ResullTankLocatlonProductCaoacltvProduct Level Ullaqe Result
P*ssI0t lv Dtl 12 h g/
2
3
4
5
6
I hereby certify the above test results:
Steve Lyons
u}o054
UTT-1038
l/t.uul t,,t spe r/ iorv
Tests were performed witH Estabrook Ezy Chek non-
volumetric tank tester.
2III S MAIN ST, SPANISH FORKUT84660
PHoNE aol -362{)971 . [e-mail]
Utah Petroleum Storage Tank Program
Previous Pollution incidents Faciliry to#J_,XD3flo
This letter, or an equivalent, must be signed and submiffed as a requirement for receiving a
Certifi cate of Compliance.
To:Mr. Brent H. Everett
Director
Division of Environmental Response and Remediation
Dear Mr. Everett:
As required by paragraph 19-6-413 of the Utah Underground Storage Tank Act, I have performed
a tank and line tightness test on each tank at my facility. Based on this test, there has not been a
release of petroleum. Additionally, based on "customary business inventory practices standards" I
am not aware of any release of petroleum from my tanks.
o
Or, if a release is known to have occurred at this facility:
I have had the following releases of petroleum (detailed below; also indicate the actions you have
taken to clean up the release):
.-;t
Srgnature ot owner/operator
Failure to report previous releases could invalidate your Certificate of Compliance.
ppiform 1022