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HomeMy WebLinkAboutRHINEHART OIL CO LLC - INSURANCE CERTIFICATE (2)® "� o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VYYY) D9/262D2D 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.lf " SUBROGATION IS WAIVED, sub)ect 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.N Minneapolis MN Office CONTACT NAME:. (866) 283-7122 FAX (800) 363-0105 (NC. No..Ext): NC. No.:. 5600 west 83r'd street 8200 Tower, suite 1100 E-MAIL. ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Minneapolis MN 554.37 USA ' INSURED INSURER A. United states Fire Insurance CO. 21113 Parkland (U.S.) Holding Corp. Rhinehart Oil CO.,LLC P.O-. Box 418 INSURERS: Allied world National Assurance Company 10690 INSURER&: Navigator's Insurance Co _ _ 42307__ American Forks UT 84003 USA INSURER D: - INSURER E:- COVERAGES CERTIFICATE NUMBER: 570081087159 — 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 OROTHER 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 r o uested LTR' TYPE OF INSURANCE INSO WVD POLICY NUMBER ADD ' - "' POLICYE V0 _ _ LBNrS- X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR - . EACH OCCURRENCE $1-,0001000 umLNIL PREMISES Ea occurrence $300,000 MED EXP (Anyone person) included PERSONAL B ADV INJURY $1,000,000 GENIAGGREGATE LIMIT APPLIES PER: POLICY ❑JEO- �X LOC OTHER: GENERALAGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG E2,000,000 A AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY - AUTOS ONLY 5068969686 07/31/2019 07/31/2020 COMBINED SINGLE LIMIT ccidenn $1,000,000 BODILY INJURY ( Per Person) BODILY INJURY (Par accident) - PROPERTY DAMAGE Per accident B X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE 03107874 07/31/2019 07/31/2020EAcrlOCCURRENCE f5,000,000 AGGREGATE _ E5,000,_000 DED X RETENTION f10,000 " -WORKERS COMPENSATION AND EMPLOYERS' LUABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE El OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If Yes, describe under DESCRIPTION OF OPERATIONS below NIA N/A PER STATUTE OTH- EACH ACCIDENT _ E.L. DISEASE -EA EMPLOYEE - - E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ADORD 101, Add@lo_n_al Remarks Schedule, my be aRech_ ed N more space Is requlred) Evidence of Insurance. CERTIFICATEIHOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POUCHES 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 e>�osa i%'L�YfGViLE�eEL71 LlsLG ✓s8A ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD25 (2016103) The ACORD name and logo are registered marks of ACORD 71 AGENCY CUSTOMER ID: 57000006950.4 LOC M Av ADDITIONAL R Aon Risk services Central, Inc. see certificate Number: 570081087159 CODE NAMEDINSURED Parkland (U.S.) Holding Corp. I see Certificate Number: 570081087159 I I EFFECTIVE DATE: _of_ I _ I ACORD 101 (20=01) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000069504 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Central, Inc. NAMEDINSURED Parkland (U.S.) Holding Corp. POLICY NUMBER see certificate Number: 570081087159 CARRIER see certificate Number: 570081087159 NAIC CODE EFFECTIVE DATE: AUUI IIVNAL HkMAHF.b 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 Harts Gas & Food LLC Rex oil Company Inc Rtfinehart Acquisition Corp ACORD 101 (200e1011) 62009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD