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114170 COCA-COLA REFRESHMENTS USA INC - INSURANCE CERTIFICATE
AC6Ji CERTIFICATE OF LIABILITY INSURANCE f`i DAM IMMIDDIYYYY) 4/25/2014 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(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 endorsement(s). PRODUCER Beecher Carlson Insurance Services 6 Concourse Parkway, Suite 2300 Atlanta, GA 30328 CONTACT NAME: ATL Judith Boich PHONE FAX N E-MAIL ADDRESS: lbolch0beechercarison.com INSURII AFFORDING COVERAGE NAILS INSURER A: Ace American Insurance Company 22667 W .beechercarlson.com INSURED Coca-Cola Refreshments USA, Inc. f/kla Coca-Cola Enterprises Inc. 11+1 In 0 DBA Coca-Cola Bottling Co Greeley 1200 7th St Greeley CO 80631 INSURER B: XL Insurance America Inc. 24554 INSURER C: Indemnity Insurance Company of North America 43575 wsuRERD: NSURER E: WSURERF: COVERAGES CERTIFICATE NUMBER: 19967412 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 LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDD POLICY EP MMIDDIWYY LIMITS COMMERCIAL GENERALLIABIUTY HDO G27334325 5/1/2014 5/1/2015 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE ❑✓ OCCUR PREMISES Meoccumxlce $ 50,000 MED EXP (An arse on) S 5,D00 PERSONAL S ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE f 4,000,000 ✓ O. POLICY JEa 7 LOC PRODUCTS - COMPIOP AGO f 5,000,000 f OTHER B AUTOMOBILE LABILITY RAD 943766501 (ADS) 5/1/2014 511/2015 a COMBINEDSINKiLk LIMIT f 5,000.00 BODILY INJURY (Per person) f B ANY AUTO ALL OVMED SCHEDULED AUTOS AUTOS NON --OWNED HIRED AUTOS AUTOS RAD 943765601(MA) 5/112014 5/1/201$ BODILY INJURY (PeraaidMO f PROPERTY DAMAGE (Per axidentl f E UMBRELLA LIAR OCCUR EACHOCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DEC i I RETENTIONS $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTAT OFFICERAIEM ER EXCLUDED?ANY LIABILITYYIN (Mandatory In NH) � N/A WLR C47889078 (AOS) WLR C4788908A (AZ,CA,MA) SCF C47889091 (WI) 5I12014 5/1/2014 5112015 5111201$ H- UTE E.L. EACH ACCIDENT f 1.000,000 E.L DISEASE - EA EMPLOYEE S 1,000,000 Ir yea d»er escNwfd DESCRIPTION OF OPERATIONS W. E.L. DISEASE -POLICY LIMIT S 1.000,000 A Excess WC WCU C47889108 5/112014 5/12015 Statutory Excess of $1MM each accident (GA, LA. Ml, OH, OK, OR, WA) for listed stales except MA -Statutory Excess of $500,000 for each accident DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, AdeHlonal RemarMs Schedule, may be attached It more space Is required) 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 © 1988.2014 ACORD ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CCRT NO.: 19967412 (ATL) Judith Boich 4/25/2014 10:07:00 AM IPM) Page 1 of 1 Beecher Carlson Insurance Services 6 Concourse Parkway, Suite 2300 Atlanta, GA 30328 City of Fort Collins PO Box 580 Fort Collins CO 80522 MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonlineTM Sender: (ATL) Judith Boich Phone: 678-539-(4800 Subject: Colo RefresFOments Certificate of Liability; Coca - Date: 4/25/2014 No. of Pages: 2 URL: www.beechercarlson.com Attached is the renewal certificate of insurance for Coca-Cola Refreshments USA, Inc and all of their subsidiaries. If you no longer require this certificate, please write delete across it and fax it to 770.870.3031 (no cover page is required Judith L. Boich Jboich@beechercarlson.com THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRMLEGED, CONFIDENTIAL AND EXEMPT ROM DISCLOSURE UNDER APPUCABLE 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 DISSEMINATION. DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THI8 COMMUNICATION IN ERROR, PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE. AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. 0 2002 Certificate of Insurance Delivered by eeertsonlinen' Insurance Visions, Inc. All rights reserved.