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HomeMy WebLinkAbout128575 REX OIL COMPANY INC - INSURANCE CERTIFICATE (2)REXOC-1 OP ID: JK ACOQQDD/YYYY) DATE (MM/ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2016 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 CONTACT Association Ins. Marketing Inc PHONE Jeffrey D. Kahns FAx P.O. Box 631610 Arc No Ext : 303-674-8685 vc No : 303-674-8819 Highlands Ranch, CO 80163 ADDRESS: Jeffrey D. Kahns ss:lkahns aimcolorado.com INSURER(S) AFFORDING COVERAGE NAIC q INSURER A: Continental Western Insurance 10804 INSURED Rex Oil Company, Inc INSURER B : Pinnacol Assurance Company 41190 P O Box 211098 Denver, CO 80221 INSURER C : INSURER D: INSURER E : INSURER F : COVFRAGFS 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 IWV POLICY NUMBER MM/DDYYY MM DDY EXP LIMITS LTR D /Y A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE a OCCUR CDP3057930-20 04/01/2016 04/01/2017 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,00 X POLICY F�' PRO- a JECT LOC u PRODUCTS - COMP/OP AGG $ 2,000,00 Emp Ben. $ 1,000,00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 BODILY INJURY (Per person) _ $ A X ANY AUTO CDP3057930-20 04/01/2016 04/01/2017 ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS INTN POLL X MCS90 X $ $ $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accldent X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 8,000,00 AGGREGATE $ 8,000,00 A EXCESS LIAB CLAIMS -MADE CDP3057930-20 04/01/2016 04/01/2017 DIED I X I RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? �N/A (Mandatory in NH) 2324112 02/01/2016 02/01/2017 STATUTE ERH E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) UER I IFIUA 1 t HOLUtK 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