HomeMy WebLinkAboutPEPSI-COLA METROPOLITAN BOTTLING COMPANY INC - INSURANCE CERTIFICATE (3)ACORD. CERTIFICATE OF LIABILITY INSURANCE
Inno16
DATE
t2/17/201417/2014
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(a).
PRODUCER LOCKTON COMPANIES
2100 ROSS AVENUE, SUITE 1400
DALLAS TX 75201
214-969-6700
NTACT
a Ne Ell: FAX
A/c Ne lk
E-MAIL
COVERAGEINSURERIS1 AFFORDING
INSURER A: ACE American Insurance Company
22667
INSURED PEPSI-COLA METROPOLITAN BOTTLING COMPANY, INC.
1069518 PEPSICO, INC.
ONE PEPSI WAY
SOMERS NY 10589
INSURER B : Indemnity Insurance Co of North America
43575
INSURER C : ACE Fire Underwriters Insurance Company
20702
INSURER D, A ri General Insurance Company
42757
COVERAGES PEPSI01 b 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 km
TypE OF INSURANCE
ADDL
INSD
BR
POLICY NUMBER
IuCY EFF
VC P
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
lr
N
HDOG27338252
1/In015
I/1n016
EACH OCCURRENCE
5000000
DAMA E TO RENTED
PREMI E Ee ocw n
2,000,000
MED EXP (Any meperson)
1,000
PERSONAL B ADV INJURY
s 5,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POUCY[:]JRej F—] LOC
OTHER
GENERAL AGGREGATE
aS000O00
PRODUCTS - COMP/OPAGG
It 5,000,000
s
A
AUTOMOBILE
LIABILITY
ANYAUTOBODILY
AUTOS NED A�ESULEO
HIRED AUTOS AUUTOOS ED
N
N
See AnaChed
1/1/2015
1/1/2016
COMBINED SINGLE LIMIT
Ea acddent
S See Below
X
INJURY (Per person)
$ XXXXXXX
BODILY INJURY (Per accdent
$ XXXXXXX
PerraccitlTMDAMAGE
$ XXXXXXX
SXXXXXXX
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
NOT APPLICABLE
EACH OCCURRENCE
s XXXXXXX
AGGREGATE
$XXXXXXX
DED I I RETENTION It
$
B
A
C
D
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVM YIN
OFFICER/MEMBER EXCLUDED?
(Ma^NtorYinNH)
DEIt es, describe under
SCRIPTION OF OPERATIONS Below
NIA
N
WLRC48019420 ADS
WLRC48019432 AZ,CA,MA)
SCFC48019444( I
WLRC4814507�(TN)
1/1/201$
1/1/2015
1/1n015
1/1n015
I/I/2016
1/1nD16
1/1/2DI6
I/In016
PER OTH-
X SrATUE FR
E.L. EACH ACCIDENT
$ 5000000
E.LDISEASE-EAEMPLOYEE
5000000
E.L. DISEASE -POLICY LIMIT
1SOOO OOO
A
A
A
Excess Workers Compensation
N
N
WCUC48019456b'OH,WA-F-L
WCUC480194681OH-PC Metro
WCUC4801947A(WV-PC MeU
1/12015
1/1/2015
)1/12015
1/I2016
1/l/2016
1/In016
WC Statutory Limits
S5,000,000 each accident
$5,000,000 each ee for disease
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Artech ACORD 101, AddiBonal Remarks Schedule, may be Beached I more space is required)
CERTIFICATE HOLDERS INCLUDE: ITS OFFICERS, AGENTS AND EMPLOYEES.
10988312
THE CITY OF FORT COLLINS
215 NORTH MASON STREET - 2ND FLOOR
PO BOX 580
FORT COLLINS CO 80522-0580
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2014/01)
The ACORD name and logo are registered marks of ACORD