HomeMy WebLinkAbout128575 GRAY OIL COMPANY - INSURANCE CERTIFICATE (6)ACORD
PRODUCER
INSURED
FEDERATED MUTUAL INSURANCE COMPANY
Home Office: P.O. Box 328
Owatonna, MN 55060
Phone:1-888-333-4949
GRAY OIL COMPANY INC
804 DENVER AVE
FORT LUPTON CO 80621
Y' [NSUR�INC'E DATE 16 h;DDIYY)
08/17/11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR
A FEDERATED SERVICE INSURANCE COMPANY
COMPANY
B
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.
LT
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDIVYI
POLICY EXPIRATION
GATE IMMIDDIYY)
UMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE Fx I OCCUR
OWNER'S & CONTRACTOR'S PROT
640229
10/01/11
10/01/12
GENERAL AGGREGATE
S 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
PERSONAL & ADV INJURY
5 11000,000
EACH OCCURRENCE
e 11000,000
FIRE DAMAGE (Anv one fire)
1, 100.000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS,.
HIRED AUTOS -
NON -OWNED AUTOS
_
640229
10/01/11 ..
.
10/01/12
-
COMBINED SINGLE LIMIT
e 1,000,000'
X
'BODILY INJURY'�
(Per Bar eonl
'S �• •
X
BODILY INJURY
(Per accident)
.5 - -
X
PROPERTY DAMAGE
$
GAR AGE LIABILITY
NV AUTO
AUTO ONLY EA ACCIDENT
$
OTHER THAN AUTO ONLY,
EACH ACCIDENT
e
MESS LIABILITYEACH
FORM
OTHER THAN UMBRELLA FORM
640235
10/01/11
10/01/12
OCCURRENCE
5
AGGREGATE
e 5 000
g,000000U0AUMBRELLA
e
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: E%CL
TWO STATU- OTH
BY IMIT EN
EL EACH ACCIDENT
EL DISEASE - POLICY LIMIT
a
EL DISEASE - EA EMPLOYEE
5
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS
BlsuaD CITY OF FORT COLLINS
PO BOX 580
FORT COLLINS CO 80522-0580
58 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL TO MAIL n
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 COMPANY. ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ,i