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HomeMy WebLinkAboutTRI-STATE OIL RECLAIMERS INC - INSURANCE CERTIFICATEOP ID: DG CERTIFICATE OF LIABILITY INSURANCE DATE02114D/YYYY) 1 znanz THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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 endorsements . PRODUCER 307-632-5566 Willis of Wyoming, Inc. -Chey 307-637-7151 1904 Warren Avenue P.O. BOX 947 Cheyenne, WY 82003 CONTACT Dana Gregory AIc° No EM:307-632-5566 a No: 307-637-7151 EMAIL ADDRESS: dana. re o willis.com PRODUCER TRIST-8 CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Tri-State Oil Reclaimers, Inc. 1770 Otto Road . Cheyenne, WY 82007 INSURERA:Great West Casualty Company 11371 INSURER B: RSUI Group, Inc. 22314 INSURER C:Endurance American Specialty 41718 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TR TYPEOFINSURANCE ADDL B POLICY NUMBER MM /DD/YYYYI (MMIDDNYYYI LIMITS C GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I OCCUR EIL10101255700 05116/11 05116114 EACH OCCURRENCE $ 1,000,00 DAMAZI Es Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JECT El PRO LOC PRODUCTS - COMP/OP AGO $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO - ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS CLP817450 02115/12 02115113 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X X $ $ B UMBRELLA LIAB EXCESS LIAB 'X OCCUR CLAIMS -MADE NHA055608 - 02115112 02115113 EACH OCCURRENCE $ 1,000,00 X AGGREGATE $ 1,000,00 DEDUCTIBLE RETENTION 3 $ $ C WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A EIL10101255700 WY STOP GAP 05/16112 05/16/14 WC STATU- X OTH- E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE$ 1,B00,00 EL.DISEASE -POLICY LIMIT It 1,000,00 A Cargo Liability Broad Form CLP817450 02115/12 02/15113 Limit 10,00 Ded 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CITYFFO City of Fort Collins Enviromental Service Div ATTN: Carol Webb PO Box 580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE X'5� ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD