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HomeMy WebLinkAbout498970 HILL ENTERPRISES INC DBA HILL PETROLEUM - INSURANCE CERTIFICATE (4)HILLE-3 OF ID: SF A�Ro CERTIFICATE OF LIABILITY INSURANCE D09/2412ATE 014Y) os/za/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 endorsements . PRODUCER PFS Insurance Group - DV 7200 S Alton Way, Ste A-140 CONTACT PHONE FAX IAID No Est): INC, No): E-MAIL ADDRESS: Centennial, CO 80112 Jim Olafson INSURERS AFFORDING COVERAGE NAICN INSURER A: Nationwide Agribusiness Ins Co 28223 INSURED Hill Enterprises, Inc., DBA Hill Petroleum 6301 Ralston Road INSURER 8: Pinnacol Assurance Co 41190 INSURER C: Arvada, CO 80002 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: RFVISIONNIIMRFR- 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 rypE OF INSURANCE A D SDew POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LMBILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR CPP104980A 10/01/2014 10/01/2015 E TO RENTED PREMISES JE. ceeunence $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL B ADV INJURY $ 1,000,00 X Blkt Add'llns'd X Blkt Wvr of Sub GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ee sBciCeDISINGLE LIMIT $ 1,000,00 X BODILY INJURY (Per person) $ A ANY AUTO CPP104980A 10/01/2014 10/01/2015 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY IPer accitlenU $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE PER ACCIDENT $ X MCS90 $ BIkt AI X Blkt WOS X UMBRELLA LIAS X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAB CLAIMS -MADE CU104980A 10/01/2014 10/01/2015 DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERNEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4148287 BLKTWOS 06/01/2014 06/01/2015 WC STATUS OTH- X TOR,IMITS X ER EL. EACH ACCIDENT $ 500,00 E. L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 A Property COP104980A 10/01/2014 10/01/2015 Buildings 9,460,70 Ded $5,000 BPP 700,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ANach ACORD 101, Additional Remarks Schedule, If mom space Is required) If required by written agreement, the certificate holder is included as additional insured for ongoing operations under general liability and designated insured under automobile liability (except hired and non -owned automobile). CITYFCI City of Fort Collins P.O. 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 ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD