HomeMy WebLinkAbout133693 CGRS INC - INSURANCE CERTIFICATEUr IU: KC
A`ORO CERTIFICATE OF LIABILITY INSURANCE
02/26/2014
°021M6/2014'
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
PFS Insurance Group - JT
4848 Thompson Pkwy, Ste 200
Johnstown, CO 80534
Dave Janssen
CONTACT
NAME:
PHONE PAX
INC, No Ext: INC, No:
E-MAIL
ADDRESS:CRODUCERRI
E,CGRS-1
INSURE S AFFORDING COVERAGE
NMCB
INSURED C G R S, Inc. & l^
CATESTCO,LLC 36`7
I
INSURERA: Admiral Insurance Company
24856
INSURERS: Hanover American Ins. Co.
36064
Green Back Operations, Inc.
1301 Academy Court
Ft. Collins, CO 80524
INauRERc:Alimerica Financial Benefit
41840
INSURER D: PInnacol Assurance Co
41190
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
R
TYPE OF INSURANCE
POLICY NUMBER
EFF
MMIDDYIVYYY
Y UP
MM ODIYYYY
LIMITS
A
A
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE r-xl OCCUR
X
FEI-ECC-13290
BLANKET ADD'L INS
BLANKET WAIVER
03/01/2014
03/01/2014
03/01/2015
03/01/2015
EACH OCCURRENCE
$ 1,000,00
PREMISES Eaomunence
E 50,00
MED EXP (Any one person)
S 5,00
PERSONAL SADVINJURY
E 1,000,00
X
GENERAL AGGREGATE
E 2,000,00
GENL AGGREGATE
POLICY
LIMIT APPLIES PER:
FX PRO- LOC
PRODUCTS - COMP/OP AGG
a 2,000,OW
S
C
C
C
C
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNEDAUTOS
BlIct Al S Waiver
AW4-A232142
$1000 DIED COMP
$1000 DED COLL
03/01/2014
03/01/2015
COMBINED SINGLE LIMB
(Ea aaidenq
$ 1,000,
X
BODILY INJURY (Per Person)
$
BODILY INJURY (Per acudenl)
E
PROPERTY DAMAGE
(PERACCIDENT)
$
X
X
$
X
I
It
A
UMBRELLA LUIB
'EXCESS UAB
X
OCCUR
CLAIMS -MADE
FEI-EXS-13291
0310112014
03/01/2015
EACH OCCURRENCE
E 4,000,00
X
AGGREGATE
$ 4,000,00
DEDUCTIBLE
RETENTION $ 0
$
X
$
D
E
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORRARTNERIEXECUTNE Y/N
OFFICERIMEMBER EXCLUDED? ❑
(Mandatory In NH)
I(yas, desaibe under
DESCRIPTION OF OPERATIONS below
NIA
4029480 CO
C4632690 CA
0110112014
01101I2014
O1I01/2015
01I01/2015
X WC STATU- X OTH-
E.L. EACH ACCIDENT
S 1,000,00
E.L. DISEASE - EA EMPLOYEES
1,000.00
E.L. DISEASE -POLICY LIMIT
S 1,000,00
B
A
Equipment Floater
(Pollution/Prof
RZ4-A231842
FEI-ECC-13290
0310112014
03101/2014
03/01/2015
03101/2015
Rented 200,00
Per claim 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ARAah ACORD 101, Addidonal Rsmarlls Schedule, B Ruse apace 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
4
U 1988-ZOOV ACUKU cUKFUKAI Ion. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD