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HomeMy WebLinkAbout168310 SCHRADER OIL CO - INSURANCE CERTIFICATE (15)SCHRA-4 OP IDGIRTI DATE(MM/DD/YYYY) 1 09/14/2017 ACORO CERTIFICATE OF LIABILITY INSURANCE `Iihl� 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER 719-593-5814 Legacy Insurance Network, LLC 3455 riargate Blvd., Ste. 215 CONTACT Tim Gries PHONE FAX 719-593-5814 719-388-2075 (A/c, No, Ext): (A/C, No): EMAIL tim@legacyinsurancebroker.com ADDRESS: Colorado Springs, CO 80920 Brian Gries INSURERS AFFORDING COVERAGE NAIC # INSURER A:Pinnacol Assurance 41190 INSURED Schrader Oil Company 320 N College Ave INSURER B: Philadelphia Indemnity 18058 Fort 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 TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR PHPK1644973 05/01/2017 05/01/2018 EACH OCCURRENCE $ 1,000,000 TO RENTED DAMES PREMI occurrence 300,000 $ MED EXP (Any oneperson) $ Excluded PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X PEST LOC POLICY ❑ OTHER: GENERAL AGGREGATE $ 2,000,000 DUCTS $ 2,000,000 B AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTODS ONLY X AUOTOS ONES PHPK1644973 05/01/2017 05/01/2018 COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Per per on) $ BODILY INJURY Per accident $ X PPerr.CCRder, DAMAGE $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB581574 05/01/2017 05/01/2018 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED I X I RETENTION $ 10000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY OFFICER/MEMBER/ EXCLUDED?ECUTIVE a (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4180714 10/01/2017 10/01/2018 X PER OTH- TAT TE R E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITYY-2 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 l ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD