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HomeMy WebLinkAbout128575 REX OIL COMPANY INC - INSURANCE CERTIFICATEREXOC-1 OP ID: CK ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/10/2015 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 CONTACT Jeffrey D. Kahns PHONE FAX tA/C, No Est:303-674-8685 A/c No: 303-674-8819 Highlands Ranch, CO 80163 Jeffrey D. Kahns EMAIL jkahns@aimcolorado.com ADDRESS: INSURERS) AFFORDING COVERAGE NAIC e INSURER A:Pmnacol Assurance Company 41190 INSURED Rex Oil Company, Inc INSURER B: Continental Western Insurance 10804 �o(K� dba Gray Oil Company D✓ P O Box 211098 INSURER C : Denver, CO 80221 INSURER D: INSURER E : INSURER F : 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 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 L SUB POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MWDD IDDIYYYY) B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR $10,000 PD Deduc CDP3057930-20 04/01/2016 04/01/2016 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 X MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JE � El LOC OTHER GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMPIOP AGG $ 2,000,00 Emp Ben. $ 1,000,00 B AUTOMOBILE LIABILITY I ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X''NON-OWNED HIREDAUTOS AUT X CAB CDP3057930-20 04/01/2015 04101/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGES Per accidentMCS90 S B UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE CDP3057930-20 04/01/2015 04/01/2016 EACH OCCURRENCE $ 8,000,00 X AGGREGATE $ 8,000,00 DED I X RETENTION$ 0 $ A 'WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? a (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N /A 2324112 02/01/2015 02JO112016 X STATUTE ER E.L. EACH ACCIDENT S 1,000,00 E.L. DISEASE -EA EMPLO $ 1,000,00 E.L. DISEASE -POLICY LIMIT 1 000 00 E , DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITYO-G City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD