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HomeMy WebLinkAboutRHINEHART OIL CO INC - INSURANCE CERTIFICATE (8)r-12/7/2016 TE (MM/DDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE �i 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). rDUCER CONTACT Tina SchubergNAME:SInsurance-Corporate Office PHONE AA/C. NoExt: (800)548-1494A C. No: (651)355-6359 Box 64422 ADDE-MRIESS.tina.schuberg@chsinc.com INSURER(S) AFFORDING COVERAGE NAIC 0 St. Paul MN 55164-4422 INSURERA:Farmland Mutual Insurance Co 13838 INSURED INSURER B : Rhinehart Oil Co Inc INSURERC: PO BOX 418 INSURER 0: INSURER E : American Fork UT 84003 INSURERF: rnVFRAr.FR CFRTIFICATF NIIMRFRr16/17 CERTS 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 ADDL SUB POLICY NUMBER MMIDDIYYYY MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR AMA E TO RENTED PREMISES Ea occurrence)$ 1,000,000 MED EXP (Any one person) $ Excluded CPPI17238A 11/1/2016 11/1/2017 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO JECT E'LOC X POLICY 7 PRODUCTS - COMP/OPAGG $ 2,000,000 Employee Benefits $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOAUTOS SAUTOS CPP117238A 11/1/2016 11/1/2017 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED X NON -OWNED AUTOS MCS-90 INCLUDED $ CA9948 BROAD POLLUTION X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 A EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 0 $ CU117238B 11/1/2016 11/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y N ANY PROPRIETOR/PARTNER/EXECUTIVE WCC117236A 7/1/2017 7/1/201B E X STAT UTE ER E.L. EACH ACCIDENT $ 500,000 A OFEXCLUDED? Ll (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYE - $ _ 500,000 E.L. DISEASE -POLICY LIMIT 1 $ 500,000. If es, describe under D SCRIPT!nN nF OPERATIONS below A ,CARGO/PROPERTY IN TRANSIT COP117238A 11/1/2016 11/1/2017 LIMITS 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Insurance CFRTIFICATF Hr11 r1FR CANCFI 1 ATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins PO BOX 580 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins, CO 80522 AUTHORIZED REPRESENTATIVE Jeff Pridey/TSCHU © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (2014Ct ) ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDMlYY) 6/27/2017 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 CAS Insurance -Corporate Office PO Box 64422 St. Paul MN 55164-4422 CONTACT Tina Schuber NAME: g PHONE A/C No t • (800) 548-1494 A/C No): (651) 355-6359 ADDRIL tina.schuberg@chsinc.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Farmland Mutual Insurance Co 13838 INSURED Rhinehart Oil Co Inc PO BOX 418 American Fork UT 84003 INSURER B :Nationwide Agribusiness Ins Co INSURER C : INSURER D : INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER:16/17 PKG 17/18 WC 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 LT LTR A DL UBR POLICY NUMBER MM DDPOLICY /YYYY MM/DDfYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE �_ X_ OCCUR PREMISES AMA E OE. occurRENTErence) $ 1,000,000 MED EXP (Any one person) $ Excluded CPP117238A 12/16/2016 11/1/2017 PERSONAL a ADV INJURY $ 1,000,000 CGLB049 BROAD POLLUTION GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO JECT ❑ LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CPP117238A 12/16/2016 11/1/2017 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED X HIRED AUTOS X AUTOS IICS-90 INCLUDED $ CA9948 BROAD POLLUTION X UMBRELLA LIAB X OCCUR li EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 0 $ CU117238B I12/16/2016 11/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE WCC117238A 7/1/2017 'I 7/1/2018 X PER STATUTE ER E.L. EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A CARGO/PROPERTY IN TRANSIT COP117238A 12/16/2016 11/1/2017 LIMITS 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER City of Fort Collins PO Box 580 Fort 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 Jeff Pridey/ACOAT ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Gray Oil Company Doing Business As Rhinehart Transportation Co LLC Additional Named Insured Harts Gas & Food LLC Additional Named Insured Kwick & Kleen Car Washes LLC Additional Named Insured R & J Land LLC Additional Named Insured Rex Oil Company Inc Doing Business As Rhinehart Land Co LLC (Owns Office Bldg/Harts Land) Additional Named Insured Service Equipment & Leasing LLC Additional Named Insured OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC