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HomeMy WebLinkAbout114170 COCA-COLA BOTTLING CO - INSURANCE CERTIFICATEBeecher Carlson Insurance Services
2002 Summit Boulevard, Suite 900
Atlanta. GA 30319
City of Fort Collins
PO Box 580
Fort Collins CO 80522
MAIL DOCUMENT
Certificate of Insurance Delivery by ecertsonline TM
Semler,:; (ATL) Judith Boich
Phone: 678-539-4827
Certificate of Liability: Coca-Cola Refreshments
5�9 USA, Inc.
Date:,; 10/6/2010
No.,of Pages: 2
"URL_ www.beechercadson.com
Dear Certificate Holder:
Please read this important information concerning the enclosed certificate.
The enclosed certificate of insurance is being issued in anticipation of the acquisition of
Coca-Cola Enterprises Inc.'s (CCE) North American operations, by The Coca-Cola Company.
The enclosed certificate will be effective upon the official close of The Coca-Cola Company's
acquisition of CCE, which is anticipated to be on October 2, 2010.
Once the transaction is complete, Coca-Cola Enterprises Inc. will become Coca-Cola Refreshments
USA, Inc. Subsequently, if the named insured on your certificate previously reflected Coca-Cola
Enterprises Inc., the new certificates will reflect Coca-Cola Refreshments USA, Inc. f/k/a Coca-Cola
Enterprises Inc.
Also, be advised that Beecher Carlson Insurance Services is now the Broker of Record for The
Coca-Cola Company and its subsidiaries.
Should you have any questions, please send an email to client.servicesl@beechercarlson:com.
Sincerely,
Judith L. Boich
(fax) 503.914.5439
THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIALAND EXEMPT FROM DISCLOSURE UNDER APPLICABLE
LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBYNOTIFIED THAT ANY
DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE, AND RETURN
THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE.
0 2002 Certificate of Insurance Delivered by ecertsonlinoTM Insurance Visions, Inc. All rights reserved.
ACORO® CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DDIYYYY)
1 6 2 1
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 Beecher Carlson Insurance Services
CONTACT NAME: ATL Judith Bo(ch
PHONE • 678-539-4827 A/c No: 678-539-4890
2002 Summit Boulevard, Suite 900
Atlanta, GA 30319
E-MAIL ADDRESS: bOICh beechercarlson.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Ace American Insurance Company
22667
www.beechercarlson.com
INSURED Coca-Cola Refreshments USA, Inc.
B: National Union Fire Insurance Company
19445
f/k/a Coca-Cola Enterprises Inc.
DBA Coca-Cola Bottling Co Greeley
1200 7th St
-INSURER
INSURERC: New Hampshire Insurance Company
23841
INSURERD: Indemnity Insurance Company of North America
43575
Greeley CO 80631
INSURERE:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 8499899 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
INSR
SUER
POLICY NUMBER
MMIDDYIYYYY EFF
LICY EXP
MM /DD/YYYY
LIMITS
A
GENERAL LIABILITY
HDOG25521468
10/2/2010
5/1/2011
EACH OCCURRENCE
$ 2,000,000
COMMERCIAL GENERAL LIABILITY
PREMISESa occurrence
$ 50,000
MED EXP (Any one person)
$ 5,000
CLAIMS -MADE OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 5,000,000
$
POLICY PRO LOC
B
AUTOMOBILE
LIABILITY
3976614 (AOS)
10/2/2010
5/1/2011
Eoac tlentSINGLE LIMIT
$ 5,000,000
/
v
BODILY INJURY (Per person)
C
B
A LIL OWNED Y AUTO
AUTOS AUTOS
e SCHEDULED NON -OWNED
HIRED AUTOS AUTOS
3976615 (MA)
3976616 (VA)
10/2/2010
10/2/2010
5/1/2011
5/1/2011
BODILY INJURY (Per accident)
$
pe0accdentDAMAGE
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
EXCESS LIAB
DED RETENTION $
$
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
WLR C46140308 (AOS)
10/2/2010
5/1/2011
ToRr LIAMITS I loj�-
E.L. EACH ACCIDENT
$ 1,000.000
A
ANY PROPRIETOR/PARTNER/EXECt1TIVE
OFFICER/MEMBEREXCLUDED7 ❑
NIA
SCF C4614031A (WI)
10/2/2010
5/1/2011
E.L. DISEASE - EA EMPLOYEE
$ 1,000000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
A
Excess WC (AZ, CA, LA, MD, NV, OR
WCU C46140321
10/2/2010
5/1/2011
Statutory Excess of $1MM each accident
RI, WA, MA)
�WCU
for listed states except MA -Statutory
A
Excess WC GA & OH
C46140333
10/2/2010
5/1/2011
Excess of $500,000 for each accident
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins
PO Box 580
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins CO 80522
AUTHORIZED REPRESENTATIVE
GA�,�
ATL Robert W. Hessel
©1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
CERT NO.: 8499899 (ATL) Judith Boich 10/6/2010 2:24:03 PM Page 1 of 1
Beecher Carlson Insurance Services
2002 Summit Boulevard, Suite 900
Atlanta, GA 30319
MAIL DOCUMENT
Certificate of Insurance Delivery by ecertsonline TM
City of Fort Collins
PO Box 580
Fort Collins CO 80522
Dear Certificate Holder:
Please read this important information concerning the enclosed certificate.
Sender* (ATL) Judith Boich
Phone: 678-539-4827
Certificate of Liability: Coca-Cola Refreshments
Sub�eCty, USA, Inc.
Date.; 10/5/2010
,.ls* BURL www.beechercarlson.com
, xa
The enclosed certificate of insurance is being issued in anticipation of the acquisition of
Coca-Cola Enterprises Inc.'s (CCE) North American operations, by The Coca-Cola Company.
The enclosed certificate will be effective upon the official close of The Coca-Cola Company's
acquisition of CCE, which is anticipated to be on October 2, 2010.
Once the transaction is complete, Coca-Cola Enterprises Inc. will become Coca-Cola Refreshments
USA, Inc. Subsequently, if the named insured on your certificate previously reflected Coca-Cola
Enterprises Inc., the new certificates will reflect Coca-Cola Refreshments USA, Inc. f/k/a Coca-Cola
Enterprises Inc.
Also, be advised that Beecher Carlson Insurance Services is now the Broker of Record for The
Coca-Cola Company and its subsidiaries.
Should you have any questions, please send an email to client.services1@beechercarlson:com.
Sincerely,
Judith L. Boich
(fax) 503.914.5439
THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE
LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY
DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE, AND RETURN
THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE.
0 2002 Certificate of Insurance Delivered by ecertsontineTM Insurance Visions, Inc. All rights reserved.
ACORb® CERTIFICATE OF LIABILITY INSURANCE
(MM/DD/YYYY)
710/5/2010
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 Beecher Carlson Insurance Services
CONTACT NAME: ATL Judith Boich
PHONE IAJC. No Ext 678-539-4827 FAX A/C No): 678-539-4890
2002 Summit Boulevard, Suite 900
Atlanta, GA 30319
E-MAIL ADDRESS: 'boich beechercarlson.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURER A: Ace American Insurance Company
22667
www.beechercarlson.com
INSURED Coca-Cola Refreshments USA, Inc.
f/k/a Coca-Cola Enterprises Inc.
DBA Coca-Cola Bottling Co Greeley
1200 7th St
INSURER B: National Union Fire Insurance Company
19445
INSURERC: New Hampshire Insurance Company
23841
INSURER D : Indemnity Insurance Company of North America
43575
INSURER E:
Greeley CO 80631
INSURER F :
COVERAGES CERTIFICATE NUMBER: 8486996 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
TYPE OF INSURANCE
ADDL
SUER
NUMBER
POLICPOLICY
MM/DDY/YYYY
MM DD/YYYY
LIMITS
A
GENERAL LIABILITY
HDO G25521468
10/2/2010
5/1/2011
EACH OCCURRENCE
$ 5,000,000
COMMERCIAL GENERAL LIABILITY
PREMISES Ea RENTED
$ 50,000
CLAIMS -MADE F—IOCCUR
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 10,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 10,000,000
POLICY PRO LOC
$
B
AUTOMOBILE
LIABILITY
3976614 (AOS)
10/2/2010
5/1/2011
Ea MIND SINGLE LIMIT
$ 5,000.00
BODILY INJURY (Per person)
_
$
C
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
3976615 (MA)
10/2/2010
5/1/2011
BODILY INJURY (Per accident)
$
B
NON -OWNED
HIRED AUTOS AUTOS
3976616 (VA)
10/2/2010
5/1/2011
R P.E dentDAMAGE
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$
DED RETENTION $
$
$
D
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? ❑
N/A
WLR C46140308 (AOS)
SCF C4614031 A (WI)
10/2/2010
10/2/2010
5/1/2011
5/1/2011
WC STATU- O� I -
TORY LIMITS
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory In NH)
If yes, describe under_J'000.00
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS below
A
Excess WC (AZ, CA, LA, MD, NV, OR
RI, WA, MA)
WCU C46140321
10/2/2010
5/1/2011
Statutory Excess of $1MM each accident
for listed states except MA -Statutory
A
Excess WC GA & H
WCU C46140333
10/2/2010
5/1/2011
Excess of $500,000 for each accident
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
City of Fort Collins, Colorado, its officers and employees are included as Additional Insured (if required by contract) on the above General Liability
policy but only with respect to liability arising out of the operations of the Named Insured.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PO Box 580
ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins CO 80522
AUTHORIZED REPRESENTATIVE—_
/y//^/
eg".0
(ATL) Robert W. Hessel 94
©1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
CERT NO.: 8486996 (ATL) Judith Stich 10/5/2010 2:12:00 PM Page 1 of 1