IPC FUEL DISTRIBUTION-2017 - Laserfiche WebLink

Home Browse Search

FORM M0840 Revfseri 01/05/2017 I . No.:23304M Eipirat!®n of/39✓a0Z0 USDOT Numbor:_____--�-__ Onto Received: ------' A Feder t ,Aucrcy may not conductor sponsor, and a person is not requiral In respond to, nor shat I a person he snbj xt w a ponnILy for failure in ccuupip cvdh a col lection of information subQct to the requieemaus of the Papeneork Reduafion Act unless that col lection of information displays a current salid OMB Control Number, l'hc LIMB Control Nutria for this in(onnation aolleetion is 2126-0068, Public reporunt, for this collection of submaadou is e sthn€llad to b alapro ,in a(05 2 minutes pu respousc. Include- the lime for renewing instructions, gain nng the data needed, and comptcfir and tvuimving the collacuen of sbarllijson- All r estionses to this collection of unrnmtaaon are mandomry. Send comments regarding this burden estinwreor any other aspect ordris culection of into mnflan. including gagoostions ter ndueine this burdcct to: labommbon Collcction Clearance Off icer. Federal Motor Carrier &aAt-y Administration, hICAMA, Washington, U.C.20590. United State Department of Transportation faYy Federal Motor Carrier Safety Administration End orsementfor Motor Carrier Policies of Insurance for Public Liability under Sections 29 and 30 of the Motor Carrier Act of 1980 Vista Enerqv Transport, Inc. DBA: Vista Enerqy Issued to Transport: Swain Oil Transport Inc. of PO Box 131,567 Carlsbad CA 92013 tblutor Carrier antra) (Molar CnrrierstaMar province) Dated at 12,14 PNI on this 31 day of.4lay. � 2017 Amending Policy Number, ad=R7 —Ql effective Date: 4;'112017 Name of Insurance Company: plaza Insurance Company Countersigned by: (anihoritatil mnlixis i eptiscvattive) The pal icy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown. (check only one): t rZ'(isutsurnsre ispruruvt/ andille uwrryarnlslinEt nut tvhatLlot alsount., intwcarsgf5 1.000,000 for rnrh acciifrrd_ Q Lhisiv to nnc, is rnr*.-nB rive rnrpaay �trsil oat t+eta6re)brmva.r¢tr>Rt_u ssof$ s`rrearl auutrvrr t. ce.;>ejflte wrderlrtiugliruitgfi ,ore<ra cadent. 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: 1.800-225-8927 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 (rano the date the notice is mailed, proof of mailing shall be sufficient proof of optical, and (21 if the insured is subject to the FMCSFl`s registration requirements under 4 r 1`_ 1L,rr; by providing thirgr (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 m Washington, DC). Filings must be transmitted on line via the Internet at hit a:fwurwt.trncsa,dat�goufarrs, (continued on next page) FORM MOSAO Pao S of a