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HomeMy WebLinkAbout168310 SCHRADER OIL CO - INSURANCE CERTIFICATE (8)SC H RA-4 OP ID: GRTI ,4CORo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/29/2018 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 have ADDITIONAL INSURED provisions or 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 719-593-5814 Legacy Insurance Network, LLC 9 Y 13540 Northgate Estates Dr#210 Colorado Springs, CO 80921 Brian Gries CONTACT Tim Grles NAME: PHONE 719-593-5814 FAX 719-388-2075 (A/c, No, Ex1): (A/c, No): E-MAIL tim@legacylnSurance r0 er.com -ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A:Pinnacol Assurance 41190 INSURED Schrader Oil Company 320 N College Ave Fort Collins, CO 80524 INSURER B: Philadelphia Indemnity 18058 INSURER C : 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 DDL UBR POLICY NUMBER POLICY EFF POLICY EXPITR LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR PHPK1808188 05/01/2018 05/01/2019 EACH OCCURRENCE $ 1,000,000 DAPREMMISES Ea occurrenceAGE TO RENTED 300,000 $ MED EXP (Any oneperson) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PEP� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED LNON-OWNED AUTOS ONLY AUTOS ONLY PHPK1808188 05/01/2018 06/01/2019 COMBINED SINGLE LIMIT Ea accident 1,000,000 $ X BODILY INJURY Perperson) $ BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB625827 05/01/2018 05/01/2019 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DE D X RETENTION $ 10000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY OFFICER/MEMBER /EXCLUDED?ECUTIVE N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4180714 10/01/2018 10/01/2019 X PER OTH- STATUTE ER E. L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITYY-2 City of Ft Collins Po Box 580 Ft 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. Ali rights reserved. The ACORD name and logo are registered marks of ACORD