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HomeMy WebLinkAboutPEPSI-COLA (PEPSICO INC) - INSURANCE CERTIFICATEACORD. CERTIFICATE OF LIABILITY INSURANCE vlrzola GATE/17/2012 12/17/2012 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(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 LOCKTON COMPANIES, LLC-N DALLAS 717 N. HARWOOD, LB#27 DALLAS TX 75201 214-969-6700 CONTACT NAME: (PA C INEFAX No E=t : aD No E-MAIL ADDRESS: INSURERINSURERSI AFFORDING COVERAGE NAIC e INSURER A: ACE American Insurance Company 22667 INSURED.PPEPSI-COLA METROPOLITAN BOTTLING COMPANY, INC. 1327006 PEPSICO, INC. ONE PEPSI WAY SOMERS NY 10589 INSURER B: Indemnity Insurance Co of North America 43575 INSURER C: uR NS RER E' INSURER : COVERAGES PEPSI01b CERTIFICATE NUMBER: 10988312 REVISION NUMBER: XXXXXXX 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 INSR SUER iWD POLICY NUMBER POLICY EFF IMMIDD I POLICY EXP (MMIDDfYYfYl LIMITS A GENERAL LIABILITY Y N HDOG2701513A 1/1/2013 1/I/2014 EACH OCCURRENCE 5000000 PRAEMISES EaEoccunence 2,000,000 X COMMERCIAL GENERAL LIABILITY - s CLAIMS -MADE ERI OCCUR MED EXP (Any oneperson) 1,000 PERSONAL R ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 5,000,000 .. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 5000000 - -, POLICY JECT El LO A AUTOMOBILE LU1BILfrY-�, •_.- - •N N ISAH08713212 I/l/2013 I/I/2014 COMBINED SINGLE LIMIT Ea accident $ 10,000 000 BODILY INJURY (Per person)' $ XXXXXXX X ,- ANYpAUTO ° AUTOS NED AUTOSULED - BODILY INJURY (Per accident $ XXXXXM HIREDAUTOS NON -OWNED "" PerOPERT DAMAGEAUTCS,_ $ XXXXXXX $XXXXXXX UMBRELLA LNB OCCUR - EACH OCCURRENCE - $ XXXXXXX EXCESS LIAR CLAIMS -MADE NOT APPLICABLE.. AGGREGATE $ XXXXXXX DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS Lueanv -YIN N WLRC47128110 ADSS))) I/l/2013 1/1/2014 WC STATU- OTH- X Toav LIMITS EL EACH ACCIDENT' ' $ 5C 000000 A ANTPROPRIETORIPARTNEWE%ECUTIVE WLRC47128122 AZ,CA,MA) I/l/2013 1/I/2D14 A OFFICEILMEMBER EXCLUDED? N❑ NIA SCFC47128134( 0 - I/l/2013 I/I/2014 EL. DISEASEEAEMPLOYEE' S000000 (Mandatory In NH) I yBs dasvibeuMer .... -r ... _ DESCRIPTION OF OPERATIONS nelw m .._ ._ ... ..-. _ F.L DISEPSE-POLICY LIMIT-_- 5000000 A Excess Workers Compensation N N WCUC47128158(OH-PC Metro I/l/2013 I/I/2014 WC Statutory Limits A WCUC4712816A(WV-PC Metr )1/1/2013 I/I/2014 $5,000,000 each accident $5,000,000 each Ce for disease DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDERS INCLUDE: ITS OFFICERS, AGENTS AND EMPLOYEES. ) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10988312 AUTHORIZED REPRESENTATIVE THE CITY OF FORT COLLINS 215 NORTH MASON STREET - 2ND FLOOR PO BOX 580 FORT COLLINS CO 80522-0580 ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD l�1 ***************IMPORTANT NOTICE***************** TO CERTIFICATE HOLDER We want to share with you some important information regarding certificates of insurance. The Texas Legislature passed and Governor Perry signed Senate Bill 425 to become effective January 1, 2012. This law will require certificate of insurance forms to be filed with and approved by the Texas Department. of Insurance before they can be used after the "effective date of the law: In addition, the law explains current Texas Department of Insurance - rules that a certificate of insurance must not obscure or misrepresent the coverage prodded by the insurance policies. Definition of "Certificate" includes checklists, affirmations, and electronic forms. .. After January 1, a certificate holder who requires an agent or policyholder to use an unapproved form or insert inappropriate language on a certificate may be sued by the Attorney General for injunctive relief or to recover a civil:penalty of up to $1,000 for each such requirement. An insurance agency could incur significant penalties of up to $1,000 for each violation under chose rules and the new law, including the�revocation of the agency's insurance license, if a certificate were issued exactly as the certificate holder requested. • - - . For this reason, after 1/l/12 we will issue the standard certificate of insurance . form and may not be able to comply with some of the items you request. Certificate holders can mail certificate forms and special wording requests for approval to: P&C Intake Unit Texas Department of Insurance 333 Guadalupe Austin, T% 78701 ca""'emalnr tch state t+c nc Please contact us with any questions you may have. LOCNTON COMPANIES OF DALLAS, LLC PO Box 671195 Dallas, TX 75267-6799 Phone: 214-969-6700/ 214-969-6759