HomeMy WebLinkAboutWESTERN ENTERPRISES - INSURANCE CERTIFICATEACORD,„ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
2/23/2009'
PRODUCER Phone: 440-249-4711 Fax: 440-249-5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Britton -Gallagher and Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
6240 SOM Center Rd. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Cleveland OH 4419 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURED
Western Enterprises, Inc.
13513 W. Carrier Road
Carrier OK 73727
CAVFRAr:r-S
INSURERS AFFORDING COVERAGE I NAIC #
I NSURER A: L e X i n q
I NSURER B: G r a n i t
INSURERC:Arch S
INSURER D:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY NUMBER
POLICYEFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERALLIABILITY
1619930-01
2/15/2009
2/15/2010
EACHOCCURRENCE
$ 1 000 000
X COMMERCIALGENERAL LIABILITY
PREMISES Eaoccurence
$50 000
CLAIMSMADE Fx -] OCCUR
MEDEXP(Arryoneperson)
$
PERSONAL aADVINJURY
$ 1 000 000
GENERALAGGREGATE
$ 2 000 000
GENL AGGRE GATE LI MIT APPLI ES PE R:
PRODUCTS -COMP/OPAGG
$ 2 000 000
POLICY7MPRO LOC
B
AUTOMOBILE
X
LIABILITY
ANYAUTO
CA93835947
2/15/2009
2/15/2010
� OMccUeer-d) SINGLE LIMIT
$ 1, 000, 000
BODILY INJURY
(Pet persm)
$
ALL OWNEDAUTOS
SCHEDULEDAUTOS
BODILYINJURY
(Peracciderd)
$
X
X
HIREDAUTOS -
NONdWNEDAUTOS
PROPERTY DAMAGE
(Per aociderd)
$
GARAGE LIABILITY
AUTOONLY-EAACCIDENT
$
OTHER THAN EA ACC
$
ANYAUiO
$
AUTO ONLY: AGG
C
EXCESSIUMBRELLALIABILITY
ULP0004577
2/15/2009
2/15/2010
EACHOCCURRENCE
$ 4 000 000
AGGREGATE
$ Lj 000 000
X OCCUR CLAIMS MADE
$
DEDUCTIBLE
Fx]RETENTION
$
$ 10 000
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC TH-
ORYLIMITS
IMfER
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACHACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE -POLICY LIMIT
$
SPECIAL PROVISIONSbebw
OTHER
DESCRIPTION OF OPERATIONS) LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SP ECIAL PROVISIONS
dditional Insureds: City of Fort Collins & its Officers, Agents and Employees
id# 6093 - 4th of July Fireworks
Display Date: July 4, 2009
Location: City Park; Fort Collins, CO
l.CP7 1 Irl%.,A1 f C r1 VLLJCIR
City of Fort Collins
P.O Box 580
Fort Collins CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORD:ED REPRESENTATIVE
ACUHU 2s (2ool/os) m ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
AUUKU 25 (ZUU1 /US)