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HomeMy WebLinkAboutGREENBACK OPERATIONS INC - INSURANCE CERTIFICATE (2)UP IU: KC AiiC"MEYCERTIFICATE OF LIABILITY INSURANCE DAT11/27112 ) 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 endorsements . PRODUCER Phone:970-635-9400 CONTACT PFS Insurance Group - JT 4848 Thompson Pkwy, Ste 200 Fax: 970-635-9401 Johnstown, CO 80534 Dave Janssen PHONE FAX Alc Ne EAI' INC, No): E-MAIL ADDRESS: PRODUCER_ CUSTOMER ID a:CGRS--1 INSURER(S)AFFOROING COVERAGE NAICN INSURED C G R S, Inc. & CA TESTCO, LLC ......;> GreenBack Operations, Inc. 1301 Academy Court Ft. Collins, CO 80524 INSURER A: Endurance American Spec INSURER B: Endurance American Spec INSURER C: Pinnacol Assurance 41190 INSURER D: Hartford Insurance Co. 00914 INSURER E : Zurich -American Ins Co. 16535 INSURER F : COVERAGES CERTIFICATE NUMBER: 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 ADDL'SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/V1'1'Y MMIDDIriri LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX7 OCCUR ECC101014122-00 BLANKET ADD'L INS BLANKETWAIVER 03I01112 03/01/12 03I01/13 03/01/13 EACH OCCURRENCE DAMAGE TO RENTED - PREMISES (Ed occurrence) MED EXP (Any one person) PERSONAL SADVINJURY $ 1,000,000 $ 50,000 $ 5,000 $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER POLICY R IFCPROn LOC PRODUCTS - COMPIOP AGG $ 2,000,00 1 $ D D D AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS Blkt Al & Waiver 34UUNKD8613 $1000 DIED COMP $1000 DIED COLL 03/01/12 03/01/13 COMBINED SINGLE LIMIT (Ea accidenp $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accmenp $ X X $ X $ A UMBRELLA LIAB E%CESS LIAB X OCCUR CLAIMSAMADE EXS101014123-00 03/01/12 03/07113 EACH OCCURRENCE $ 4,000,00 X AGGREGATE $ 4,000,00 DEDUCTIBLE RETENTION $ D $ X Is C E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORJPARTNERIEXECUTIVE YIN OFFICERIMEMBER F�ICLUDED? (Myyantlrtory in NH) 0 SCRIPTIONOF OPERATIONS below NIA 4029480 CO WC4632690 CA 01/01/13 01/01/13 01/01/14 01/01/14 WC STATU- �. �OTH- X TORV_LIMIT$ ^ 1 ER EL EACH ACCIDENT $ 1,000,00 EL DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,00 A Pollution/Prof oFloater I E C101014122-00 03/01/12 I 03/01/13 IPer claim 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, if more space is required) If required by written agreement, the certificate holder is included as additional insured for ongoing operations under general liability. CITYOFC City of Fort Collins PO Box 580 Fort Collins, CO 80522 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD