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HomeMy WebLinkAbout128575 GRAY OIL COMPANY - INSURANCE CERTIFICATECERTIFICATE OF INSURANCE ISSUED BY ASSOCIATION INSURANCE MARKETING, INC POBOX68 EVERGREEN CO 80437.0068 FAX 303 674 8819 303 674 8685 / 800 5718685 Insured GRAY OIL CO, INC 804 DENVER AVENUE FT LUPTON, CO 80621 TO WHOM IT CONCERNS Company Affording Coverage PINNACOL ASSURANCE 7501 EAST LOWRY BLVD DENVER, CO 80230 (303 361 4000) This is to certify that PINNACOL ASSURANCE has issued a Standard Workers' Compensatlon and Employers' Liability Policy as described below covering the liability unposed upon subject employers by the Workers Compensation Act of Colorado, said policy being in good standing as of this certificate issue date 01-29-08 POLICY NUMBER POLICY PERIOD CLASSIFICATION CODE LIMITS OF LIABILITY 1350372 02-01-08 to 02-01-09 GASOLINE DEALER & D 88350 BROKER OF RECORD BROKER CODE NUMBER G30166 ASSOCIATION INSURANCE MARKETING, INC PO BOX 68 EVERGREEN, CO 80437-0068 EMPLOYERS' LIABILITY COVERAGE Part Two of the policy, LIMIT OF EMPLOYERS LIABILITY, is as follows Bodily Injury by Accident $1,000,000 each accident Bodily Injury by Disease $1,000,000 each employee Bodily Injury by Disease $1,000,000 policy limit IMPORTANT THE COVERAGE DESCRIBED ABOVE IS IN EF CHANGE AT ANY TIME IN THE FUTURE FECT AS OF THE ISSUE DATE OF THIS CERTIFICATE TC IS SUBJECT TO CANCELLATION SHOULD THE ABOVE DESCRIBED POLICY BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF PINNACOL ASSURANCE WILL ENDEAVOR TO MAII 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON PINNACOL ASSURANCE OR ASSOCIATION INSURANCE MARKETING SPECIAL CONDITIONS CERTIFICATE HOLDER CITY OF FORT COLLINS P O BOX 580 FORT COLLINS, CO 80522-0580 AUTHORIZED REPRESENTATIVE