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HomeMy WebLinkAboutRHINEHART OIL CO INC - INSURANCE CERTIFICATE (6)AFRO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/9/2016 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 CHS Insurance -Corporate Office PO Box 64422 St. Paul MN 55164-4422 CONTACT Tina Schuber NAME: g PHONo xt• (800)548-1494 A No:(651)355-6359 ADDRESS:tina.schuberg@chsinc.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:Farml and Mutual Insurance Co 13838 INSURED Rhinehart Oil Co Inc (See Additional Named Insured Page) PO BOX 418 American Fork UT 84003 INSURER B : INSURERC: INSURERD: INSURER E : _ INSURER F: COVERAGES CERTIFICATE NUMBER:16/17 REV 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 OF INSURANCE ADDLTYPE IN" S V POLICY NUMBER MM/DDPOLICY EFF NYYY EXP POLICY DDNYYY MM LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X j OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ Excluded CPP117238A 12/16/2016 11/1/2017 PERSONAL & ADV INJURY $ 11000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO LOC JECT PRODUCTS - COMP/OPAGG $ 2,000,000 Employee Benefits $ 1,000,000 OTHER. AUTOMOBILE LIABILITY OMBINED 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 $ X X NON -OWNED HIRED AUTOS AUTOS MCS- 90 INCLUDED $ CA9948 BROAD POLLUTION X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 A EXCESS LIAB CLAIMS -MADE DED I X RETENTION$ 0 $ CU117238B 12/16/2016 11/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS below $ A CARGO/PROPERTY IN TRANSIT COP117238A 12/16/2016 11/1/2017 LIMITS 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space Is required) Evidence of Insurance CERTIFICATE HOLDER GANGtLLA I IUN 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 eff Pridey/TSCHU o " ACORD 25 (2014101) 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 Rex Oil Company Inc Doing Business As Harts Gas & Food LLC Additional Named Insured Gray Oil Company Doing Business As Kwick & Kleen Car Washes LLC Additional Named Insured R & J Land LLC Additional Named Insured Rhinehart Land Co LLC (Owns Office Bldg/Harts Land) Additional Named Insured Service Equipment & Leasing LLC Additional Named Insured Rhinehart Transportation Cc LLC Additional Named Insured OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC