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HomeMy WebLinkAbout114170 COCA-COLA REFRESHMENTS USA - INSURANCE CERTIFICATE�`� " CERTIFICATE OF LIABILITY INSURANCE DATEIMMD°"""' 4/25/2012 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(les) 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 6 Concourse Parkway, Suite 2300 Atlanta, GA 30328 CONTACT NAME:BQicb PHONE AIC No; 678.539.4890 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC i INSURER A: Ace American Insurance Company 22667 Www.beechercadson.com INSURED Coca-Cola Refreshments USA, Inc. W�11 D INSURERS: f/k/a Coca-Cola Enterprises Inc. INSURERC: INSURER D: Indemnity Insurance Company of North America 43575 DBA Coca-Cola Bottling Co Greeley 1200 7th St Greeley CO 80631 NSURERS: NSURER F : COVERAGES - CERTIFICATE NUMBER: 12933105) 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 TRINSR rypE OF INSURANUBR CE ADDL sIND POLICY NUMBER MMILDOYEFF n MMI�DIIYYYV LIMITS A GENERAL LIABILITY HDO G27009360 5/1/2012 5/1/2013 EACH OCCURRENCE S 2,000,000 COMMERCIAL GENERAL LIABILITY PREMISES E.Eoccu rr anrs $ 50,000 CLAIMS -MADE �✓ OCCUR MED EXP (Any me person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG E 5,000,000 $ POLICY PRO- LOC B AUTOMOBILE LIABILITY 4982748 (AOS) 5/1/2012 5/1/2013 COawl aEDISINGLE LIMIT S 5,000,00 ,/ BODILY INJURY (Per person) $ C ANY AUTO ALL OWNED BSCHEDULED AUTOS AUTOS 4982749 (MA) BODILY INJURY (Per accident) $ POP.ERtle^DAMAGE $ B HIRED AUTOS NON -OWNED AUTOS 4982750(VA) E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENTION$ $ S D A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERJEXECUTNE OFFICERIMEMBER E%CWDED4 (Mandatory In NH) NIA ( WLR C46140370 AOS) SCF C46140382(WI) 1/1/2012 5/1/2012 5/1/2013 5/1/2013 WCSTATU. oRk TORY LIMITS E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE E 1000.000 it yna, deaaibe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Excess WC (AZ, CA, LA, MD, NV, OR WCU C46785927 5/l/2012 5/1/2013 Statutory Excess of $1 MM each accident RI, WA, MA, GA, OH) for listed states except MA -Statutory Excess of $500,000 for each accident DESCRIPTION OF OPERATIONS I LOCATIONS I 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE ATL Robert W. Hassel ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CBRT NO.: 12933109 (ATL) Judith Boich 4/25/2012 12:52:00 PH Page 1 of 1