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F <br /> j <br /> STORAGE TANK CERTIFICATE OF INSURANCE TO <br /> DEMONSTRATE FINANCIAL RESPONSIBILITY <br /> STATE OF CALIFORNIA <br /> Facility Name and Address: <br /> Quik Stop Markets, Inc.—as on file wiftthe company <br /> Insurer Name and Address: <br /> Illinois Union Insurance Company c/o ACE Environmental Risk, P.O. Box 1000,436 Walnut Street WA07A, <br /> Philadelphia, PA 19106 <br /> Policy Number: <br /> UST G2181037A 013 <br /> Policy Periods <br /> From 12:01 am May 1,2016 to 12:01 am May 1,2017 <br /> Insured Name and Address: <br /> The Kroger Co. located at 1014 Vine Street, Suite 1000 in Cincinnati, OH 45202 <br /> I <br /> I. The Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following <br /> Underground Storage Tanks: <br /> Facility Identification No. Number of Tanks <br /> As on file with the Company <br /> for taking corrective action and/or compensating third parties for bodily injury and property damage caused by <br /> either sudden accidental releases or non-sudden accidental releases or accidental releases in accordance <br /> with and subject to the limits of liability, exclusions, conditions, and other terms of the Policy arising from <br /> operating the underground storage tanks identified above. <br /> I= <br /> 1 <br /> The Limits of Liability are: I <br /> a. $1,000,000 Each Occurrence I <br /> b. $2,000,000 Annual Aggregate <br /> exclusive of legal defense costs,which are subject to a separate limit under the policy. This coverage is provided <br /> under policy number UST G2181037A 013. The effective date of said policy is May 1, 2016. <br /> II. The Insurer further certifies the following with respect to the insurance described in Paragraph L• <br /> A. Bankruptcy or insolvency of the"insured"shall not relieve the Insurer of its obligations under the Policy to <br /> which this certificate applies. <br /> B. The Insurer is liable for the payment of amounts within any deductible applicable to the Policy to the <br /> provider of corrective action or a damaged third-party, with a right of reimbursement by the "insured" for <br /> any such payment made by the Insurer. This provision does not apply with respect to that amount of any <br /> deductible for which coverage is demonstrated under another mechanism or combination of mechanisms <br /> as specified in 40 CFR 280.95-280.102. I <br /> C. Whenever requested by a Director of an implementing agency, the Insurer agrees to furnish to (the <br /> Director) a signed duplicate original of the Policy and all endorsements. <br /> ACE USA,Copyright 2006 Page 1 of 2 <br /> I <br /> I <br /> E <br />