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Home My WebLink About128575 GRAY OIL COMPANY - INSURANCE CERTIFICATE (8)Jan-09-04 03:27P Assoc Insurance 303 674 8819 P.01 ACORDDATE CERTIFICATE OF LIABILITY INSURANCE (N WDDPIV) 1-9-2004 „ PRODUCER 303 674 8685/ FAX 674 8819 THIS CERTIFICATE IS ISSUED AS A ONLY AND CONFERS NO RIGHTS U TTER OF INFORMATION ON THE CERTIFICATE ASSOCIATION INSURANCE HOLDER. THIS CERTIFICATE DOES N ALTER THE COVERAGE AFFORDED B T AMEND, EXTEND OR THE POLICIES BELOW. P.O. BOX 68 COMPANIES AFFORD-_ OVERAGE___ EVERGREEN, , CO 80437-0068 __ - _ _ COMPANY NATIONAL FIRE & MARINE INSURANCE COMPANY A INSURED COMPANY NATIONAL INDEMNITY INSURANCE COMPANY GRAY OIL COMPANY, INC. S 804 DENVER AVE. COMPANY PINNACOL ASSURANCE FORT LUPTON, CO 80621 C FAX: 303 857 1641 COMPANY D COVERAGES 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. LDO TYPE OF IMEURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATWON UNITE DATE(EMIDOlYY) DATE(MEMOTM A GENERALLIABILITY 72LP150304 03-01-03 03-01-04 GENERAL AGGREGATE f 2,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS COMP.OP AGG f 2,000,000 I CLAIMS MADE OCCUR PERSONAL E AOY INJURY S 1 000,000 J L OWNER'SSCONTRACTOR'S PROT ACH OCCURRENCE f 1,000,000 rFIREDAMAGE(4ny onelml f 50,000 EDEXPImY a r S 5.000 B AUTOMOBILE UAWLITV 170TRN237281 03-01-03 03-01-04 COMBINED SINGLE LIMIT f 1,000,000 ANY AUTO ALL OWNED AUTOS BODILY INJURY S --- X SCHEDULEDAUTOS IPer Person) HIRED AUTOS BODILY INJURY (Per ecdeeM) f NON -OWNED AUTOS MCS-90 X — - - PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY EA ACCIDENT S ANY AUTO OTHER THAN AUTO ONLY EAQHACCIDENT f AGGREGATE I EXCESS LIABILITY FACH OCCURRENCE S ._ 1 UMBRELLA FORM AGGREGATE f OTHER THAN UMBRELLA FORM C WORKERS COMPENSATION AND 1350372 02-01-04 02-01-05 'AT IS X_ T%Y L Ml s_ .. ER EMPLOYERB' LIABILITY EL EACH ACCI#ENT f 500,000 THE PROPRIETOR/ I %( INCL .._ EL DISEASE - ROLICY LIMIT - --- __. -- -- is SOO,000 ---- -- -- PARTNERSIEXECUTIVE I OFFICERSARE EXCL --- -- - ELDISEASE- EMPLOYEE S 500000 B OTHER AUTO PHYSICAL DAMAGE 70TRN237281 03-01-03 03-01-04 $1.000 DED SPECIAL PERILS ACTUAL CASH VALUE $1,000 DIED COLLISION DESCRIPTION OF OPERATIONULOCATIONSIVEHICLES/SPECIAL ITEMS PETROLEUM MARKETER: CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED CUSTOMER, CERTIFICATE FAXED TO HOLDER @ 970 221 6707 AND INSURED 303 857 0756: PAGE 1 OF 1. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF FT. COLLINS EXPIRATION DATE THEREOF, THE ISSUING CMPAMY WILL ENDEAVOR TO MAIL ATTN. JAN 10 DAYS WRITTEN NO TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P.O- BOX 580 BUT FAILURE TO r n ALL {M00 BLI NOR LIABILITY FT. COLLINS, CO 80522 of ANY Uv THE c ry s rs o R eBENTATWES, AUTHORRED EP I CORPORATION 1!!� ACORD 254 11"