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Home My WebLink About118790 TEAM PETROLEUM A LIMITED LIABILITY COMPANY - INSURANCE CERTIFICATE (2)ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12,D22014 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. It 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 endorsements . PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT NAME: CLIENT NTACT CENTER A CNNq Est): 888-333-4949 FAX No): 507-4464664 E-MAIL CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURER(S) AFFORDING COVERAGE NAIC It INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 313-963-1 INSURER B: TEAM PETROLEUM A LIMITED LIABILITY COMPANY INSURER C: PO BOX 1831 FORT COLLINS, CO 80522 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2 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 TYPE OF INSURANCE POOL INSR SUBR D POLICY NUMBER POLICY EFF MMIDDIVYYY POLICY EXP MMIDDIVYVV LIMITS A GENERAL X LIABILITY COMMERCIAL GENERlLL LIABILITY CLAIMS -MADE X OCCUR N N 9052691 01/10/2015 01/10/2016 EACH OCCURRENCE $1,000,000 DAM bE50aocmE rtntt $100,000 MED EXP (Any am person) EXCLUDED PERSONAL& ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L X AGGREGATE POLICY LIMIT APPLIES JECTT PER: LOC PRODUCTS - COMPIOP ADD $2,DD0,ODO A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS N N 9052691 01/10/2015 01/10/2016 (CEO MBIidNED SINGLE LIMIT acc $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE acciden A X UMBRELLA LIAR 1 EXCESS LIAB X OCCUR CLAIMS -MADE N N 9065929 01/10/2015 01/10/2016 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y y N ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFDCERIMEMBER EXCLUDED? (MarMatery in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA N 9910503 02/01/2015 02/01/2016 X WCSTATUS TORY LIMITS OTN' ER E.L EACH ACCIDENT $500,000 E.L DISEASE - EA EMPLOYEE $500 DDO E.L DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (AXatln ACORD 101, Additional Remarks Schedule, it more space is required) CERTIFICATE HOLDER CANCELLATION 313-963-1 20 CITY OF FORT COLLINS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FORT COLLINS, CO 80522-0580 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