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HomeMy WebLinkAbout128575 GRAY OIL COMPANY - INSURANCE CERTIFICATE (9)GRAYO-1 OP ID: JK ,�►coRO CERTIFICATE OF LIABILITY INSURANCE �i DA04124/2014Y) oana/zola 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 endorsement(s). PRODUCER Association Ins. Marketing Inc P.O. Box 631610 NTACT xAME: Jeff Kahns PHONE FAX "ONE, Ell, 303 674 8685 ac No): 303 674 8819 EMAIL kahns aimcolorado.com ADDRESS: 1 Higghlands Ranch, CO 80163 ! Jeffrey D. Kahns /l� INSURE S AFFORDING COVERAGE NAIC0 A: Continental Western Insurance 10804 1 1INSURER INSURED Rex -Oil Company DBA Gray Oil Company 804Denver Ave INSURER B: Pin na Col Assurance 41190 INSURERC: INSURER 0: Fort Lupton, CO 80621 INSURER E: INSURER F : rnVFRAr:FS CFRTIFICATF Nt1MRFR-I 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 LTRywn rypE OF INSURANCE DOL U POLICY NUMBER ZZUDCY EFF MNOVD Y EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [AXI OCCUR CDP3057930-2 0410112014 04101/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea omuffence $ 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 PRO LOC PRODUCTS - COMP/OP AGG S 2,000,00 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDALT TOEULED AUTOS NON HIREDAUTOS AUTOS X MCS-90 X BRND POLL CDP3057930-20 04101/2014 04/0112015 COMBINEDSINGLESINGLE LIMITIE $ 1,000,00 BODILY INJURY (Par person) $ BODILY INJURY (Per amaem) $ PROPERTY DAMAGE PER ACCIDENT S $ A X UMBRELLA LIAR EXCESS LAB X OCCUR CLAIMS -MADE CDP3057930-20 0410112014 04/0112015 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DED X RETENTION$ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) I0 SCdesUnder RIPTTIiONOFOPERATIONS nel. NIA 2324112 02/0112014 02/0112015 X WCSTATU- OTH- OFYIMI E.L. EACH ACCIDENT g 1, I00,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE -POLICY LIMIT S 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1D1, AEEMonal Wmaraa Uc ule, ff more "P la r uln ) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Fort Collins PO Box 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522-0580 AUTHORIZED REPRESENTATIVE "a� ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD