HomeMy WebLinkAbout128575 GRAY OIL COMPANY - INSURANCE CERTIFICATE (2)ACORDP CERTIFICATE OF LIABILITY
INSURANCE DATE/YYI
01 /22/0z/o6
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
FEDERATED MUTUAL INSURANCE COMPANY
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR
5701 W Talavi Boulevard
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Glendale AZ 85306
Phone 1 888 333 4949
Home Office Owatonna MN 55060
_ COMPANIES AFFORDING COVERAGE
COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR
A FEDERATED SERVICE INSURANCE COMPANY
INSURED
GRAY OIL COMPANY INC
804 DENVER AVE
316 453 0
COMPANY
B
COMPANY
FORT LUPTON CO 80621
C
COMPANY
D
COYMA43ES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE 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
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IMMIDDNYI
POLICY EXPIRATION
DATE IMMIDD/YYI
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
6 2 OOO oO0
X
PRODUCTS COMP/OP AGG
6 2 000 000
A
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE IX I OCCUR
9802287
03/01/08
03/01/09
PERSONAL & ADV INJURY
6 1 000 000
EACH OCCURRENCE
6 1 000 000
OWNER S & CONTRACTOR S PROT
FIRE DAMAGE IA y o e h at
6 100 000
MED EXP IAny one person)
6
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
9 1 000 000
X
BODILY INJURY
Per perso I
6
A
ALL OWNED AUTOS
SCHEDULED AUTOS
9802287
03/01/08
03/01/09
_
X
HIRED AUTOS
NON OWNED AUTOS
BODILY INJURY
IPer accident)
6
X
PROPERTY DAMAGE
9
GARAGE LIABILITY
AUTO ONLY EA ACCIDENT
6
OTHER THAN AUTO ONLY
ANY AUTO
EACH ACCIDENT
6
AGGREGATE
6
EXCESS LIABILITY
EACH OCCURRENCE
6 4,000,000
A
X UMBRELLA FORM
9802288
03/01/08
03/01/09
AGGREGATE
_
6 4 000 000
6
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
WC 5TATU OTH
RV LIMITS R
EL EACH ACCIDENT
6
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
EL DISEASE POLICY LIMIT
8
EL DISEASE EA EMPLOYEE Is
_
OFFICERS ARE EXCL
OTHER
i
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
CERnF{CATE HOLDER
CANCELLATION
3164530 CITY OF FORT COLLINS
58 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
PO BOX 580
EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
FORT COLLINS CO 80522 0580
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPAIV ITS AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENTATIV
AOORD 29 iS {1r9Si
PRESt s eACORO CORPORAVON 190