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HomeMy WebLinkAbout114170 COCA-COLA BOTTLING CO GREELEY - INSURANCE CERTIFICATE (5)A �® CERTIFICATE OF LIABILITY INSURANCE DAM(MMIDDIYYY) 4/2212011 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 endomement(s). PRODUCER Beecher Carlson Insurance Services CONTACT NAME: ATL Judith Boich PHONE AIc. No Eau 678-5394827 AIc NP: 678-5394890 2002 Summit Boulevard, Suite 900 Atlanta, GA 30319 EWAIL ADDRESS: botch beechercarlson.com INSURER ($) AFFORDING COVERAGE NAIC 0 INSURER A: Ace American Insurance Company 22667 www.beechercadson.com INSURED Coca-Cola Refreshments USA, Inc. f/k/a Coca-Cola Enterprises Inc. DBA Coca-Cola Bottling Co Greeley 1200 7th St 120 INSURER e: National Union Fire Insurance Company 19445 INSURER C: New Hampshire Insurance Company 23841 INSURER D: IndemnityInsurance Company of North America 4357$ Greeley CO 80631 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 10030850 REVISION NUMBER: THIS IS TO CERTIFY THAT THE PCLICIES OF INOURANCE LISTED BELOW HAVE BEE::SSUED 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. IN$R TR OF INSURANCE ADDTYPE INSR WVD POLICY NUMBER MMADDrYYYY LICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY HDO G25521481 5/1/2011 5/1/2012 EACH OCCURRENCE $ 2,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence 8 50,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE F —./] OCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 4,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 5,000,000 $ 17 POLICY PRO-LOC B AUTOMOBILE LIABILITY 3506190(AOS) 5/1/2011 5/1/2012 EeeBINEDISINGLE LIMIT $ $BBB 000 BODILY INJURY (Per person) $ C B ANY AUTO ALL OWNED e SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 3506191 ( MA) 3506192(VA) BODILY INJURY (Par accidanl) S PROPERTY ec TY DAMAGE E E $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ E Is D A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVEr��I OFFICERIMEMSER EXCLUDED? l� U—Ndaw,Y GJJR) NIA WLR C46140370(AOS) SCF C46140382(WI) 5/1/2011 5/1/2011 5/1/2012 5/1/2012 H TWC STAMITS OR E E.L. EACH ACCIDENT S 1000 00 E.L. DISEASE - EA EMPLOYEE E If yes, describe ender DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT I b 1,000.00 A Excess WC (AZ, CA, LA, MD, NV, OR WCU C46140394 5/1/2011 5/1/2012 Statutory Excess of $1 MM each accident RI, WA, MA) for listed states except MA -Statutory A Excess WC GA & OH WCU C46140400 I 5/l/2011 5/1/2012 Excess of $500,000 for each accident DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Addhional Remarks Schedule, H 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 (ATL) Robert W. Hassel © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 2512010/05) The ACORD name and logo are registered marks of ACORD CBRT NO.: 100308SO (ATL) 2udich Boich 4/22/2011 11:19:00 AN Page L of 1 Beecher Carlson Insurance Services 2002 Summit Boulevard, Suite 900 Atlanta, GA 30319 City of Fort Collins PO Box 580 Fort Collins CO 80522 Attached is the renewal certificate for policy period 5/1/2011 - 2012 MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonline Tm Sendeei (ATL) Judith Boich Phone: 678-539-4827 ACORD 25 (05/10) Certificate of Liability: Subject: Coca-Cola Refreshments USA, Inc. ',Date: 4/22/2011 No. ofPagesi 2 ,r;;.,.; URL WwW.beechercarlson.com If you no longer require this certificate, please write delete across it and fax it to 678.539.4890. No cover letter is required 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 DISSEMNATION, 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 ORIGNAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE 0 2002 Certificate of Insurance Delivered by eoertW ji0,T. Insurance Visions, Inc. All rights reserved.