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HomeMy WebLinkAbout103265 HAISTON OIL COMPANY INC - INSURANCE CERTIFICATE (3)ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY 06/30/2009' PRODUCER 303 674 8685 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ASSOCIATION INSURANCE MARKETING, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 68 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. EVERGREEN, CO 80437-0068 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: ZURICH INSURANCE HAISTON OIL CO, INC. INSURERS: GENERAL STAR INDEMNITY P.O. BOX 1576 INSURERC: PINNACOL ASSURANCE FORT COLLINS, CO 80522 INSURERD: INSURER E: CAVFRAnPq 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. INSR DD'L INSR TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DATEIMMIDD POLICYEXPIRATIONI,TR LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx-1 OCCUR CP09470251 07-01-09 07-01-10 EACHOCCURRENCE $ 1,000,000 MMI ESEaoccurence _ $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: RO' LOC X POLICY PE T PRODUCTS, COMP/OPAGG $ 2,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON>OWNEDAUTOS MCS-90 CP09470251 CA-9948 07-01-09 07-01-10 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Perperson) $ X BODILY INJURY (Per accident) $ X X PROPERTY DAMAGE (Per accident) $ X BROAD AUTO POLLUTI ELIABILITY IANYAUTO AUTO ONLY, EA ACCIDENT $ OTHERTHAN EAACC AUTOONLY: AGG $ $ B EXCESSIUMBRELLALIABNJW* X OCCUR CLAIMS MADE X1DEDUCTIBLE RETENTION $ 10,000 TO FOLLOW 07-01-09 07-01-10 EACHOCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ $ $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? B yes, describe under SPECIAL PROVISIONS below 3019023 02-01-09 02-01-10 X ORY LAMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE , EA EMPLOYEE - $ 500,000 E.L. DISEASE , POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS PETROLEUM MARKETER: CITY OF FORT COLLINS ATTN: JIM HIME P.O. BOX 580 FORT COLLINS, CO 80522 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGAT-*W-0—RWt-1LIWY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED TION 1988 Fit!h!iCE '(RI.T U L 27