2012-11-13_REVISION - C1981008 - Laserfiche WebLink

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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. LTR TR TYPE OF MSURANCE W R SUM ID INDONYYYI UNITS DYYM MI POLICY NUMBER 9&DIY A GENERALLUBLLITY 008844193 O1 /01/14 WIWI EACH OCCURRENCE $ 1,000,000 1 X COMMERCIAL GENERAL IABILITY DAMAGE TO RENTED PREMISES (Ea occonemni $ 100,000 ' 1 CLAIMS -MADE i X OCCUR MED EXP (Any one per on) $ X 1 , BBL $1,000,000 PERSONAL 8 ADV INJURY $ 1,000,000 - GENERAL AGGREGATE j ,$ 2.000,000 _ GEN'L AGGREGATE LIMB APPLIES PER PRODUCTS - COMP/OP AGG 1 $ 2.000, 000 POLICY l ! TO LOC 'Misplays. Benefits ,S 1,000,000 } AUTOMOBILE LIABILITY CAB003292103 01/01/12 01/01/1 COMBINED SINGLE UNIT III S 1,000,000 (Ea acddaM) X_ ANY AUTO BODILY INJURY (Per Freon) 1 $ , ALL OWNED AUTOS BODILY INJURY (Per accdeM) $ SCHEDULED AUTOS ' ____. PROPERTY DAMAGE $ X I HIRED AUTOS 1 (Per accident X NONOWNED AUTOS $ _ _ C X UMBRELLA LJAB it X ' OCCUR ', 8812 816 07 4 O1 /01/1 01/01/13 EACH OCCURRENCE ( 0 25,000,000 1 EXCESSUAB 1 CLAIMS -MADE) AGGREGATE }$ 25,000,000 I DEDUCTIBLE 14 X I RETENTION $ 10.000 I $ WORKERS COMPENSATION WC STATU- ' OTH- 1 TORY I MRS FR AND EMPLOYERS' LIABILITY y / N E L EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE' OFFICERIMEMBER EXCLUDED? I N (Mandatory in NH) E L DISEASE - EA EMPLOYE $ H yea dear1DN order DESCRIPTION OF OPERATIONS babes E L DISEASE - POUCY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schuh,* 9 mom space is ner ACORN 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 LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED :PRESENTATIVE 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 Iieu of such endorsement(s). PRODUCER 1- 612 - 333 -3323 Hays Companies 80 South 8th Street Suite 700 Minneapolis, MN 55402 NSURED Western Fuels - Colorado, LLC P.O. Box 628 Nucla, CO 81424 CERTIFICATE HOLDER kpaimos ACORD 25 (2009109) 24908606 CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE NUMBER: 24908606 CONTACT RAKE: PHON 612- 333 -3323 ED IA L Ert) ORE PRORUSS PROWLER CUSTOMER W It INSURER(5) AFFORDING COVERAGE INSURER A LEXINGTON INS CO NSURERB ARCH INS CO INSURER c NATIONAL ONION FIRE INS CO OF PITTS INSURER D INSURER E MSURER F CANCELLATION REVISION NUMBER: DATE(MM/DDANYY) 01/03/2012 FAx Nol 612- 373 -7270 WC, NAIC 6 19437 11150 19445 To Whom It May Concern ,r Insurance Purposes Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo a e registered marks of ACORD 10