OCEAN BLUE ENVIRONMENTAL SERVICES, INC. (4)

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FORM MCS-90 OMB No.: 2126-0008 Expiration: 3/31/2021 US DOT Number: Date Received: 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. United States Department of Transportation �W�; Federal Motor Carrier Safety Administration 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 OCEAN BLUE ENVIRONMENTAL SERVICES, Issued to INC. of Long Beach, CA 90813 (Motor Carrier name) (Motor Carrier state or province) 505 Eagleview Blvd., Dated at Exton, PA 19341 on this 1" day of July, 2021 Amending Policy Number: AECO05699101 Effective Date: July 01, 2021 Name of Insurance Company: XL Specialty Insurance Company 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 $ 1, 000, 000 CSL 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: (800)688-1840. Cancellation of this endorsement may be effected by the company of 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). FORM MCS-90 Page 1 of 4 1EWED & APPROVED Y. ((REVIEWm &ppAPPRO�V/ID BY. Risk Management Analyst