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HomeMy WebLinkAbout168310 SCHRADER OIL CO - INSURANCE CERTIFICATE (4)SCHRA-1 OP ID: GRTI CERTIFICATE OF LIABILITY INSURANCE E jM%IyDDNYYY) "0621/2013 06/21/2013 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 pollcy(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 endorseme s . PRODUCER Phone: 719-593-5814 NAME CT Tim Gries 345g5By insurance Network Fax: 719388-2075 3455 Brie ete Blvd Ste 215 Springs, d0 80920 ColTim Gries Tim Cries PHONE 719-593.5814FAX C No Est:INC.No: 719388-2075 ADDRESS: tim legacyinsurancebrokencom INSURER(S) AFFORDING COVERAGE NAICM (px} - V d INSURER A: United States Fire Ins. CO. INSURED Schrader Oil Co Schrader Properties INSURER B: PInnacol 41190 Schrader Land Co INSURER C : RS& S LLP 320 N College INSURER D: Ft Collins, CO 80524 INSURER E : NSURERF: 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 REOUIREMENT, 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. IL1R TYPE OF INSURANCE POUCY NUMBER MM/UDCY EFF MMIDD1 UP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 5068738269 06130/2013 06130/2014 EACH OCCURRENCE S 1,000,00 -DAMKPREMISE'ES ET ocamence $ 100,00 MED UP (Any one person) E 5,00 PERSONAL& ADV INJURY E 1,000,00 GENERAL AGGREGATE S 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: X POLICY 7 PRO- LOC PRODUCTS - COMP/OP AGG $ 1,000,00 E A AUTOMOBILE LIABILITY ANY AUTO ALL OMSCHEDULED AUTOS AUTOS HIRED AUTOS X NON-OMED AUTOS 5068738269 06/3012013 0613012014 COMBINED SINGLE LIMIT Ee eCddenl E 1,OOD,DO BODILY INJURY(P. person) E X BODILY INJURY (Per accident)S X PROPERTY DAMAGE Per acddenl E S A X I UMBRELLA LIAB EXCESS UAB X OCCUR CLAIMS -MADE 5237077797 06/30/2013 06/30/2014 EACH OCCURRENCE S 4,000,00 AGGREGATE s 4,D00,00 DEG X RETENTIONS D 1 1 S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Myandatory In NH) DESCRIPTION OFF Oloe PERATIONS bel. NIA 4061859 10/01/2012 10/01/2013 STATU- TH- X CC T RV IMIT R E.L. EACH ACCIDENT S 500,00 E.L. DISEASE - EA EMPLOYE S 500,00 E.L. DISEASE - POLICY LIMIT S 500.00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H loon space Is requlred) 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 Tim Gries ©1988-2010 ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD