DERR-2024-006342

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UTAH STORAGE TANK CERTIFICATE OF INSURANCE
TO DEMONSTRATE FINANCIAL RESPONSIBILITY
Facility Name and Address: Per the attached Facility and Tank Schedule
Policy Number: ISPILLSB5FGE001
Period of Coverage: December 18, 2020 to December 18, 2023
Name of Insurer: Ironshore Specialty Insurance Company
Address of Insurer: 175 Berkeley Street, Boston, MA 02116
Name of Insured: 7-Eleven, Inc.
Address of Insured: 3200 Hackberry Road, Irving, TX 75063
CERTIFICATION:
1.Ironshore Specialty Insurance Company, the Insurer, as identified above, hereby certifies that
it has issued liability insurance covering the following underground storage tank(s):
Facility ID Facility Name and Address Number of Tanks
Per the attached Facility and Tank Schedule
for taking corrective action and compensating third parties for bodily injury and property
damage caused by 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 the legal defense costs, which are subject to a separate limit under the policy.
This coverage is provided under ISPILLSB5FGE001. The effective date of said policy is
December 18, 2020.
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.
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
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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 280.104-280.107.
c. Whenever requested by a 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 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
expiration of a minimum of 10 days after a copy of such written notice is received by the
insured.
e. The insurance covers claims otherwise covered by the policy that are reported to the
Insurer within six 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 eligible to provide insurance as an excess or surplus lines
insurer, in one or more states.
_________________________________________________________
Authorized Representative of Ironshore Specialty Insurance Company
Maureen Domenicone
Vice President, Authorized Representative of Ironshore Specialty Insurance Company
175 Berkeley Street
Boston, MA 02116