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Home My WebLink About118790 TEAM PETROLEUM LLC - INSURANCE CERTIFICATEACORO® CERTIFICATE OF LIABILITY INSURANCE D01/0 /2 Y3 ovos/zo13 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 INSURERS), 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 terns 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). PRODUCER NAME: JEFFKAHNS ASSOCIATION INSURANCE MARKETING, INC. PO BOX 631610 No EXt: 303-674-8685 p� Nn: 303-674-8819 ADDRESS: jeffkahns@aim.com HIGHLANDS RANCH, CO 80163 INSURERS AFFORDING COVERAGE NAIL# INSURERA: PHILADEPHIA INSURANCE 18058 INSURED TEAM PETROLEUM LLC 105 E. LINCOLN AVE INSURERB: PIN NACOL ASSURANCE 41190 INSURER C: INSURER ° INSURERE: FORT COLLINS CO 80524 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NOMRFR- 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 LTR TYPE OF INSURANCE ADDL INSINSR SU.. WVD POLICY NUMBER POLICY EFF MMIDDIYYY POLICY EXP MWD LIMITS A GENERALUABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS.MADE FRI OCCUR PHPK966305 01 10/201301/10/2014 EACH OCCURRENCE $ 1,000,000 PREMISES Ma o¢uoenc S 300,000 MED EXP(My one Person) S PERSONAL& ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER. X POLICY PRO- LOC PRODUCTS -COMP,OP AGG $ 2,000,000 Y A AUTOMOBILE LIABILITY ANY AUTO ALLONMED SCHEDULED AUTOS AUTOS NON.ED ANTS HIRED AUTOS Nx MCS -90 BROADENE PHPK966305 01/10/20130111012014 COMBINED SINGLE LIMIT Ea a¢ken $ 1,000,000 X BODILY INJURY (Per Parson) $ BODILY INJURY rlN (Per $ X PROPERTYDAMAGE (Per accdent S X $ A X UMBRELLA LIAB EXCESS LIAD X OCCUR CLAIMS -MADE PHUB408273 11/10/201 1/10/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ B WORKERSCOMPENSATION AND EMPLOYERS LIABILITY YIN OFFlCERPRIETORPARTNEI �ECUTIVEF (Mandatory in NH) If yes d.ibe under DESCRIPTION OF OPERATIONS below NIA 3092239 02/01 01302/01/2014 X V.CSTATU OTH- TORYUMrTS E. L. EACH ACCIDENT $ 1,000,000 EL. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, M more space Is required) CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522 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 JEFFREY D KAHNS 01988-2010 ACO CORPORATION_ All dnhts ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD