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HomeMy WebLinkAboutRHINEHART OIL CO INC - INSURANCE CERTIFICATE (5)ATE (MM/DD/YYYY) A� oRo® CERTIFICATE OF LIABILITY INSURANCE DE 10/11/2017 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 CONTACT Tina Schuber NAME: g CHS Insurance -Corporate Office vCO%E(800)548-1494 FAX, X (651)355-6359 x: No: PO Box 64422 ADDRIess:tina.schuberg@chsinc.com INSURERS AFFORDING COVERAGE NAIC # St. Paul MN 55164-4422 INSURER A:Farml and Mutual Insurance Co 13838 INSURED INSURERB:Nationwide Agribusiness Insurance 28223 Rhinehart Oil Co Inc INSURERC:Endurance American Insurance Co PO Box 418 INSURER D :Gemini Insurance Company INSURER E : American Fork UT 84003 INSURERF: CnVFRAt;FR CFRTIFICATF N11MI RFR-17/18 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 I LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DD(YYYY MM I D/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE x OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1, 000, 000 MED EXP (Any one person) $ Excluded CPPI17238A 11/1/2017 11/1/201B PERSONAL B ADV INJURY $ 1,000,000 CGLB049 BROAD POLLUTION GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO - POLICY ❑ LOC X PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A XANY AUTO ALL OWNED SCHEDULED �_ AUTOS AUTOS CPP117238A 11/1/2017 11/1/2018 BODILY INJURY (Per aceident) $ PROPERTY DAMAGE Per accident $ X X NON -OWNED HIRED AUTOS AUTOS MCS-90 INCLUDED $ CA9948 BORAD POLLUTION A X UMBRELLA LIAB X OCCUR CU117238B 11/1/2017 11/1/2018 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 C EXCESS LIAB CLAIMS -MADE DED X I RETENTION $ 0 EXCESS LIABILITY $ 5,000,000 EXC30000480500 11/1/2017 11/1/2018 WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE STATUTE ERH E.L. EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA A WCC117238A 7/1/2017 7/1/2018 E.L. DISEASE - EA EMPLOYEE, $ 500,000 E.L. DISEASE -POLICY LIMIT 1 $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below A CARGO/PROPERTY IN TRANSIT COP117238A 11/1/2017 11/1/2018 LIMITS 2,000,000 D EXCESS LIABIITY CEX0960251801 11/1/2017 11/1/2018 LIMITS 10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION 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/TSCHU'f © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) 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 R & J Land LLC Rex Oil Company Inc Rhinehart Land Co LLC (Owns Office Bldg/Harts Land) Service Equipment & Leasing LLC Additional Named Insured Additional Named Insured Doing Business As Additional Named insured Additional Named Insured OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC