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HomeMy WebLinkAboutPEPSI BOTTLING GROUP, INC. - INSURANCE CERTIFICATEACORD,. CERTIFICATE OF LIABILITY INSURANCE PRODUCER LOCKTON COMPANIES, LLC-N DALLAS THIS CERTIFICATE IS 717 N. HARWOOD, LB#27 ONLY AND CONFER DALLAS TX 75201 HOLDER. THIS CERTI 214-969-6700 ALTER THE COVERA INSURED Pepsi Bottling Group, Inc. 1065871 One Pepsi Way Somers NY 10589 S DATE (MM/DD/YYYY) 1 / 1 /2011 12/ 14/2009 ISSUED AS A MATTER OF INFORMATION NO RIGHTS UPON THE CERTIFICATE FICATE DOES NOT AMEND, EXTEND OR GE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Old Republic Insurance Compat INSURER B : INSURER C : INSURER D : INSURER E : NAIC # 24147 COVERAGES PEPBOOI Ell THIS CERTIFICATE OF INSURANCE DOES NOT GONSTITUTE A CONTRACT BETWEEN THE ISSUING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ; INSR ADDT POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIALGENERAL LIABILITY MWZY58521 1/1/2010 1/l/2011 DAMAGE TO RENTED_ PREMISES Ea occurence $ 100,000 CLAIMS MADE OCCUR MED EXP (Any one person) $ 1,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 PRO - POLICY JECT LOC A AUTOMOBILE LIABILITY ANY AUTO MWTB 20811 1/1/2010 1/l/2011 COMBINED SINGLE LIMIT (Ea accident) $ ],000,000 X BODILY INJURY (Per person) $ XXXXXXX ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ XXXXXXX HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ XXXXXXX GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ XXXXXXX ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: AGG $ XXXXXXX EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ XXXXXXX OCCUR CLAIMS MADE AGGREGATE $ XXXXXXX UMBRELLA El NOT APPLICABLE $ XXXXXXX $ XXXXXXX DEDUCTIBLE FORM $ XXXXXXX RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE FN-] OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under SPECIAL PROVISIONS below MWC11632800 1/I/2010 1/l/2011 X ORY IMITS OER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER $100,000 A MOTOR TRUCK CARGO MWE22224 1/l/2010 I/l/2011 DESCRIPTION OF OPERATIONS/LOCATIONSA/EHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The City of Fort Collins, its officers, agents and employees are named as additional insured with respects to General Liability and Auto Liability for any claims arising out of work performed under their agreement. The Insurance evidenced by this certificate will not be cancelled or materially altered except after ten (10) days written notice has been received by the City of Fort Collins. %,CR I Ir II,N I C rIULUCR %,AF4%,r LLA I IUIV 2814386 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City of Fort Collins DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 215 North Mason Street - 2nd Floor NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PO Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Fort Collins CO 80522-0580 REPRESENT ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD Client#: 50539 NEECO ACORDTM CERTIFICATE OF LIABILITY INSURANCE ,2/29/2009' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Flood I& Peterson Insurance Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4821 Wheaton Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P O Box 270370 Fort Collins, CO 80527 r INSURERS AFFORDING COVERAGE NAIC # INSURED ` INSURER A: Zurich The Neenan Company LLLP INSURER B: American International Companie 2620 E Prospect Rd INSURER C: Pinnacol Assurance Suite 100 INSURER D: Steadfast Insurance Company Fort Collins, CO 80525 INSURER E: Fireman's Fund Insurance, Co. COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DD POLICY EXPIRATION DATE MM DD LIMITS A GENERAL LIABILITY GL0427719405 01/01/2010 01/01/2011 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Fa occurrence) $300OOO CLAIMS MADE FX_1 OCCUR MED EXP (Any one person) $1 O 000 PERSONAL & ADV INJURY $1 00O 000 GENERALAGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 X PRO - POLICY LOC A AUTOMOBILE LIABILITY X ANY AUTO BAP427719505 01/01/2010 01/01/2011 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG B EXCESS/UMBRELLA LIABILITY BE23465048 01/01/2010 01/01/2011 EACH OCCURRENCE $10000 000 X OCCUR ❑ CLAIMS MADE AGGREGATE $10000 000 $ DEDUCTIBLE $ RETENTION $ C WORKERS COMPENSATION AND 4025258 01/01/2010 01/01/2011 X WC IIMIT ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEEI $1 000,000 OFFICER/MEMBER EXCLUDED? NO If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000 000 D OTHER Professional E00534253305 01/01/2010 01/01/2011 $5,000,000 Limit E Builders Risk MX193012901 01/01/2010 01/01/2011 $7,956,870 Limit DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS RE: #1886 Policy Services Facility. City of Fort Collins, Fort Collins Captial Leasing Corporation, Fort Collins Policy Services Facility, 2221 South Timberline Rd, Fort Collins, 80525, and US Bank National Association are included as additional insureds with respects to General Liability and Auto Liability. IC City of Fort Collins Attn: Mr. Jim O'Neill Purchasing Division PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL JMWMjjRXjt MAIL A0_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,X)(jtq( AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) 1 of 2 #S496391/M496018 NIK 0 ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001/08) 2 of 2 #S496391/M496018