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HomeMy WebLinkAboutRHINEHART OIL CO INC - INSURANCE CERTIFICATE (2)Ref. No. 320008186098 Aon Reed Stenhouse Inc. 600 - 3rd Avenue SW Suite 1800 Calgary AB T2P OG5 tel 403-267-7010 fax 403-261-0897 City of Fort Collins PO Box 580 Fort Collins, CO 80522 USA Re: Evidence of Insurance effective Insurance as described herein has been arranged on behalf of the Insured named herein under the following policy(ies) and as more fully described by the terms, conditions, exclusions and provisions contained in the said policy(ies) and any endorsements attached thereto. Insured Parkland US Holding Corporation; Rhinehart Oil Co., LLC (a Utah Company) P.O. Box 418 American Forks, UT 84003 USA Coverage 1st Excess Liability Insurer AIG Insurance Company of Canada Policy # CE24240951 Effective 31-Jul-2019 Expiry 31-Mar-2020 Limits of Liability Each Occurrence $15,000,000 In excess of the Commercial General Liability, Umbrella Liability Automobile Liability and Workers Comprehensive Policy may be subject to a general aggregate and other aggregates where applicable Terms and 1 or Additional Coverage Additional Named Insured: Gray Oil Company; Rhinehart Transporation Co., LLC; Harts Gas & Food LLC; Kwick & Klean Car Washes LLC; Rex Oil Company Inc.; Rhinehart Land Co., LLC; Service Equipment & Leasing LLC; Rhinehart Acquisition Corp. The above 1 st Excess Liability policy follows form and is in excess of the underlying Commercial General Liability, Automobile Liability, Umbrella Liability and Workers Compensation policies. THIS CERTIFICATE CONSTITUTES A STATEMENT OF THE FACTS AS OF THE DATE OF ISSUANCE AND ARE SO REPRESENTED AND WARRANTED ONLY TO City of Fort Collins. OTHER PERSONS RELYING ON THIS CERTIFICATE DO SO AT THEIR OWN RISK. Aon Reed Stenhouse Inc. Dated : 19-July-2019 Issued By: Amy,Zachary Tel: +14032677798 THE POLICY CONTAINS A CLAUSE THAT MAY LIMIT THE AMOUNT PAYABLE OR, IN THE CASE OF AUTOMOBILE INSURANCE, �� 1 of 1 THE POLICY CONTAINS A PARTIAL PAYMENT OF LOSS CLAUSE ac rto oCERTIFICATE OF PROPERTY INSURANCE DAT07/9/2E 912019 2 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. PRODUCER CONTACT NAME Aon Risk Services Central, Inc. PHONE FAX Minneapolis MN office (AID. No. Ext) (866) 283-7122 IA'C. No (800) 363-0105 5600 West 83rd Street EMAIL 8200 Tower, Suite 1100 A R Minneapolis MN 55437 USA PRODUCER S70000069504 P CUSTOMER ID A. INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: United States Fire Insurance Co. 21113 Parkland (U.S.) Holding Corp. INSURER B: Rhinehart Oil Co.,LLC INSURER C: P.O. Box 418 INSURER D: American Forks UT 84003 USA INSURER E: INSURER F: mr, i c711117792Tc7O nronu. oco. LOCATION OF PREMISES DESCRIPTION OF PROPERTY (Attach ACORD tat, Additional Remarks Schedule, If more space is required) Evidence of Insurance. 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM'DD� YYYY) POLICY EXPIRATION DATE (MMIDD,YYYY) COVERED PROPERTY LIMITS A X CAUSES PROPERTy. OF LOSS DEDUCTIBLES 0]/3!/.!u LP 07/31/2020 X BUILDING PERSONAL PROPERTY BUSINESS INCOME EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PEAS PROP BLANKET BLDG & PP Property In Transit BASIC BUILDING $9.000000 BROAD CONTENTS X SPECIAL X $37,625,000 EARTHQUAKE X $26,250.000 WINO FLOOD Blk! PP Detl X $50,000 INLAND MARINE OF LOSS NAMED PERILS TYPE OF POLICY — CAUSES POLICY NUMBER R CRIME TYPE OF POLICY BOILER & MACHINERY. EQUIPMENT BREAKDOWN SPECIAL CONDRIONS OTHER COVERAGES (ADDED 101. Additional Remarks Schedule, maybe attached if more space Is required) Lol IIFIUAI It HULUtH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins PO BOX 580 Fort Collins CO 80522 USA AUTHORIZED REPRESENTATIVE c�a�a �%Lactic cJsGuery �G ✓Tao. © 1995-2015 ACORD CORPORATION. All rights reserved. ACORD 24 (2016//03) The ACORD name and logo are registered marks of ACORD e= .0 m T D: W m z Z W Q U LL cc LU W U CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDD/YYYY) 07/29/2019 1 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 AOn Risk Services Central, Inc. Minneapolis MN office CONTACT NAME: is I0 No. Exq: (866) 283-7122 we No(800) 363-0105 E-MAIL ADDRESS: 5600 West 83rd Street 8200 Tower, Suite 1100 INSURER(S) AFFORDING COVERAGE NAIL# Minneapolis MN 55437 USA INSURED INSURER A: United states Fire Insurance CO. 21113 Parkland (U.S.) HOldinq Coro. INSURER B: Allied world National Assurance Company 10690 Rhinehart oil Co.,LLc P.O. Box 418 INSURER C: Navigators Insurance Co 42307 INSURER D: American Forks UT 84003 USA INSURER E: INSURER F: CnVFRAr%FR CFRTIFICATF NIIMRFR-.17nn7767709.5 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSO WVD POLICY NUMADDISUBIR BER MM/DOIYVVY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 x1 OCCUR E)AMAGE ToCLAIMS-MADE ENTED PREMISES Ea occurrence $300, 000 MED EXP (Any one person) Included PERSONAL &ADV INJURY $1.000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000 O. POLICY ❑ PET ❑X LOC PRODUCTS - COMPIOPAGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY 5068969686 07/31/201907/31/2020 COMBINED SINGLE LIMIT Es accident $1,000,000 BODI LY INJ U RY( Per person) X ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY OAMAGE Per accitlant B X UMBRELLA LIAR EXCESS LUIB X OCCUR CLAIMS -MADE 03107874 SIR applies per policy ter 07/31/2019 s & condi 03/31/2020 ions EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DIED I X RETENTION WORKERS COMPENSATION AND EMPLOYERS' LUIBILITY ANY PROPRIETOR I PARTNER I EXECUTIVE YIN PER OTH- STATUTE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) NIA E.L. DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of insurance. CERTIFICATE HOLDER CANCELLATION 60 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Fort Collins AUTHORIZED REPRESENTATIVE PO Box 580 Fort Collins CO 80522 USA ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000069504 LOC #: a►co ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMED INSURED parkland (U.S.) Holding Corp. POLICY NUMBER See Certificate Number: 570077677095 CARRIER See Certificate Number: 570077677095 NAIC CODE EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES Ifa policy below does not include limit infonnation, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LrR TYTE OF INSURANCE ADDL INSD SUBR 'A VD POI.IC\'N(NIBER POLICY EFFECTIVE DATE POLICY EXPIRAcrioN DATE IJ\IITS EXCESS LIABILITY C CH19EXczO26AYIV 07/31/2019 03/31/2020 Aggregate 54,000,000 Each Occurrence S1,000.000 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000069504 LOC #: A�ORo ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY Aon Risk services Central, Inc. NAMEDINSURED parkland (U.S.) Holding Corp. POLICY NUMBER See Certificate Number: 570077677095 CARRIER See Certificate Number: 570077677095 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Named insureds Gray oil company Rhinehart Transportation Co LLC Harts Gas & Food LLC Kwick & Kleen car washes LLC Rex Oil company Inc Rhinehart Land Co LLC Service Equipment & Leasing LLC Rhinehart Acquisition Corp The ACORD name and logo are registered marks of ACORD