HomeMy WebLinkAboutInterstate Sign Co., Inc. - Insurance CertificateClient#:338866 2OINTERSIG
ACORD* CERTIFICATE OF LIABILITY INSURANCE 112312025
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an €ndorsement. A statement on
this certificate does not confer any rights to the certificate holder in lieu ot such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEO BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER.
INSURER{ ) AFFOROING COVERAGE
llsuRER a: westfield National lnsuraoce companl
tNsuRER B. westfield lnsuranco company
tNsuRER c . Cincinnati Specialty Underwriters lnsco
8887468761
INSURED
24',t20
INSURER F
Ginger Cranfill CPCU
24',t12
13037
PRODUCER
Mccriff, a MMA LLG Company
4309 Emperor Blvd, Suite 300
Durham, NC 27703
9r9 281-4500
lnterstate Sign Co., lnc
1990 Rockford Street
Mount Airy, NC 27030
i#Ess gcranfill@mcg ff.com
INSURER D:
INSURER E :
, e,q, 919 28'l'4500
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
E
a
8
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEENISSUED TOlHE INSURED NAMEOABOVE FORTHE 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,
INSR
F
rYPE oF rNsuRANcE nB*
cotltMERctal GENERAL LtABtllTY X
FH.,"[ PoLrcY NUTTTBER
x lcMM2g59o7R
I
POLICY €XP
o'l t30t202dA1130t2025 EACH OCCURRENCE
DAMAGE TO RENTED
PREMI9ES (Ea @curen@)
$'1,0001000
$500,q00
$'r or!!q
$ 1q00,000
s2,000.000
s?Iq!,000
5
| "*,r".roo. [] o""u*
X PD Ded:1,000 LUEq ExP (any onepe6on)
GEN'L AGGREGATE LIM TAPPL]ES PER
PfRSONAL A ADV INJURY
GENERSIAGGREGATE
PROOUCTS, COMP/OP AGG
fl PRo. f l
L _-.1 poLrcy I I JEcr I roc
OTHER
A AUfOMOBILE LIABILITY x x cMM285907R 1t301202s o't 13012026 COMB]NEO SINGLE LIMIT
(Ea a@!9!!)
BODILY NJURY (Per peBon)
s't,000,000i!OWNED
AUTOS ONLY
HIRED
AUTOSONLY
s
x
f I scHEouLEDI lAUTosEl NoNowNEo
l^lAUTosoNLYlt
Ix 1"..,o x
l --']
"*,r.r*.
BOOILY lN.lURY (Pera6jdent)
PROPERTY OAI]AGE
Leelae!9lU
s
r
s
$5,000,000 _
$5.0QQpq0_ ,_
$
Aluuener-u r.lla
EXCESS t-tAB
x cMM285907R 1130t2025 0't t30t2026 EACH OCCURRENCE
AGGREGATE
B
DED ] ] RETENIION $
WORKERS COTIPENSATION
AND EiIPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNEFVEXECUTIVE i
OFFICER/MEMBER EXCLUOED?
(raandatory in NH)
y6, des.tibo under
DESCRTPTTON OF OPER TIONS belos
Excess Liabi
x wcP2859't4G 1t3012025 01t30t202 )tl€il*,. ilC#1
E L EA.H accrpllr I
E,L DISEASE. EA EMPLOYEE..-..^*;;il;l
$1,000,000
sl,000,000
s1,000,000
c x x csu0176583 9t3012024 09t301202 s,000,000
OESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addilional Remarks Schedule, nay be attached if mo.e spa@ is rcquned)
RE: '150917-006 Empire Petroleum Partners, LLC Diamond Shamrock 803 Riverside Avenue Fort Collins,CO 80524
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
281 N College Avenue
Fort Collins, CO 80526-0000
SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE wlLL BE DELIVERED IN
ACCORDANCE WT}I THE POLICY PROVISIONS,
AUTHORIZEO REPRESENTATIVE
'b frt'-
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