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Home My WebLink About128575 GRAY OIL COMPANY INC - INSURANCE CERTIFICATE (3)FEDERATED INSURANCEIF To Whom It May Concern, \'ORE: GRAY OIL COMPANY INC Enclosed is a certificate of insurance that has been renewed for a new policy term. If a copy of an additional insured or policy endorsement was requested, the document will be sent in a separate envelope. If you have any questions regarding this please contact: the Federated Insurance Client Contact Center at: Phone: 1-888-33 3-4949 Fax: 507-446-4664 E-mail: clientcontactcenter@fedins.com Thank you, Client Contact Center Federated Insurance Companies Enclosed: Certificate of Insurance MISC-0974 (04-13) ACCAV a ilh� CERTIFICATE OF LIABILITY INSURANCE r DATE (MM/DDNYYY) 0826/2013 I 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT CLIENT CONTACT CENTER NAMEPHONE AX AIc No EXt : 888-333-4949 FAic No): 507-446A664 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 316-453-0 INSURER B: GRAY OIL COMPANY INC INSURER C: 804 DENVER AVE INSURER D: FORT LUPTON, CO 80621 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 29 REVISION NUMBER: 0 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 LTA TYPE OF INSURANCE DL INSR SUBR WVD pDLJCY NUMBER ,POLICY POLICY EFF POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR N N 0640229 10/01/2013 10/01/2014 EACH OCCURRENCE $1,000,000 AMAGETO E OR MISES EaRof. force, menm $I00,000 MED EXP(Any one person) EXCLUDED PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE X POLICY LIMIT APPLIES PER: PRO ECT LOC PRODUCTS - COMPIOP AGO $2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS NON -OWNED AUTOS N N 0640229 10/01/2013 10/01/2014 COMBINED SINGLE LIMIT a acciden $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per acciaenil PROPERTY DAMAGE r acciden or.. A X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE N N 0640235 10/01/2013 10/01/2014 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER E%CLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WCSTATU- TORY LIMITS OTH ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atli ACORD 101. Additional Remarks Schedule, it mom space is required) 316-453-0 CITY OF FORT COLLINS PO BOX 580 FORT COLLINS, CO 80522-0580 290 L:ANt LLJ AI IVN 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 O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD