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HomeMy WebLinkAbout168310 SCHRADER OIL CO - INSURANCE CERTIFICATE (13)SCHRA-4 OP ID: GRTI .4CORO CERTIFICATE OF LIABILITY INSURANCE `..�� FDATE(MM/DD/YYYY) 09/23/2015 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 Legacy Insurance Network 3455 Briargate Blvd, Ste 215 Colorado Springs, CO 80920 Tim Gries CONTACTNAMETim Gries _ PHONE FAX AIc No Ext : 719-593-5814 AIC No): 719-388 2075 E-MAIL ac ADDRESS: 9 Y tim le Insurancebroker.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Indemnity 18058 INSURED SCHRADER OIL Co. INSURER B: Pinnacol 41190 318-320 N COLLEGE FT COLLINS, CO 80524 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR PHPK1330156 05/01/2015 05/01/2016 EACH OCCURRENCE $ 1,000,00 DAMPREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRO POLICY JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS -COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED L SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS T incl MCS90 PHPK1330156 05/01/2015 05/01/2016 COEaMBINED ccidentSINGLE LIMIT a $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ /.t, X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB498211 05/01/2015 05/01/2016 EACH OCCURRENCE $ 4,000,00 AGGREGATE $ DED I X I RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY IN ANY PROPRIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatoryin NH) If es, describe under DESCRIPTION OF OPERATIONS below N / A 4180714 10/01/2015 10/01/2016 PER OTH- STATUTE X ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CFRTIFICATF HOLDER CANCELLATION C ITYY-1 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 Tim Gries © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD