HomeMy WebLinkAbout128575 GRAY OIL COMPANY INC - INSURANCE CERTIFICATEPRODUCER
FEDERATED MUTUAL INSURANCE COMPANY
Home Office: P.O.-Box 328
Owatonna, MN 55060
Phone:1-888-333-4949
INSURED.
'GRAY OIUCOMPANY INC
804 DENVER AVE
FORT LUPTON CO 80621
DATE IM r. 4N.S.URAN.C. MIDDIVY)
F 08/27/12
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
A FEDERATED
COMPANY
B
COMPANY
C
COMPANY
D
COMPANY OR
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.
iLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YVI PDATE (MMIDDNYI� UMI I a
GENERAL LIABILITY GENERAL AGGREGATE a 2,000,000
X I COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG a L
A CLAIMS MADE � OCCUR 640229 10/01/12 10/01/13 PERSONAL & ADV INJURY a 1
OWNER'S & CONTRACTOR'S PROT I EACH OCCURRENCE a 1
MED EXP (Any one person)
a
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS.
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS ...
------640229
_
10/01/12
...-...
_..._-_
- -
_
10/01/13
.... .-
- ,- ., -
- -
COMBINED SINGLE LIMIT
a 1,000,000
X
BODILY INJURY
(Per pereoN
e
X
,. ,.., .— .e_. .✓
BODILY INJURY.
(Per accident) '
..q
a
X
PROPERTY DAMAGE
a_
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
a
OTHER THAN AUTO ONLY:
EACH ACCIDENT
a
AGGREGATE
$
A
EXCESS LIABILITY
X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
640235
10/01/12
10/01/13
EACH OCCURRENCE
a 5,000,000
AGGREGATE
a 5,000,000
a
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY_ _ _
THEPROPRIETOR/ INCL
PARTNERS/EXECUTIVE
OFFICERS ARE: E%CL
' - - -
-
-
WC TH
WC STATU-
TORV IMITS OER
EL EACH ACCIDENT
a -
EL DISEASE -POLICY LIMIT
a
EL DISEASE - EA EMPLOYEE
a
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
CITY OF FORT COLLINS
PO BOX 580
FT COLLINS CO 80522-0580
58 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABIUTY
OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE i