HomeMy WebLinkAbout128575 GRAY OIL COMPANY - INSURANCE CERTIFICATE (4)A CORDrM RT F .0 AST .. F ; L1 3 IT
ATE
. ; RAN " : ' D Ol /21 /09 Y)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
`PRODUCER
ONLY AND CONFERS NO RIGHTS, UPON THE CERTIFICATE
FEDERATED MUTUAL INSURANCE COMPANY
5701 W. Talavi Boulevard
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Glendale, AZ 85306
Phone: 1-888-333-4949
COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR
Home Office: Owatonna, MN 55060
A FEDERATED SERVICE INSURANCE COMPANY
INSURED 316-453-0
GRAY OIL COMPANY INC
COMPANY
B
804 DENVER AVE
FORT LUPTON CO 80621
COMPANY
C
COMPANY
D
.:....
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
I
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY- EXPIRATION
DATE (MMIDDIYY)
LIMITS
GENERAL
LIABILITY
GENERAL AGGREGATE
$ 2,000,000
X
PRODUCTS - COMP/OP AGG
$ 21000,000
COMMERCIAL GENERAL LIABILITY
A
CLAIMS MADE X❑ OCCUR
9802287
03/01/09
03/01/10
PERSONAL & ADV INJURY
$ 1,000,000
EACH OCCURRENCE
$ 1,000,000
OWNER'S & CONTRACTOR'S PROT
-
FIRE DAMAGE (Any one fire)
$ 100,000
t.
MED EXP (Any one person)
$
-
AUTOMOBILE
LIABILITY
ANY AUTO
- - —
- . • _. ... •-'
- --- -
COMBINED!SINGLE:'LIMIT ' :
'
$ 1-,000,000°
_
X
~BODILY -INJURY-
&
IPe`r per`s°�)
$
A
..
ALL OWNED AUTOS ..,i „t
SCHEDULED AUTOS /
HIRED AUTOS
.NON OWNED AUTOS
-..
9802287
- ...
- -
03/01•/09,
.�.
�•03/01710.
X
_BODILY. INJURYr
IPer accident)
-X
-
PROPERTY DAMAGE
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT
$
AGGREGATE
$
EXCESS LIABILITY
EACH OCCURRENCE
$ 4,000 000
AGGREGATE
$ 4,000,000
A
NUMBRELLA FORM
9802288
03/01/09
03/01/10
$
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
WC
OR STOTH
TORY LIMITMITS ER
EL EACH ACCIDENT
$
EMPLOYERS' LIABILITY
EL DISEASE - POLICY LIMIT
$
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVEROFFICERS
EL DISEASE - EA EMPLOYEE
$
ARE: EXCL
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
.: ......
GERTIFI:GRTE HOLl9EFfi .:. ?r :;: ..... ...
�.:�::..::::::::......................:::::................................................................
CANCELLATION ,;;;,;:;;:
.........................::.::................::::..:........•.....................................................................::.
3164530 ................................................................................................
CITY;,OF FORT COLLINSCJ 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 COMPAC ITS AGE TS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIV
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