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Home My WebLink About133693 C G R S INC & GREENBACK OPERATIONS INC - INSURANCE CERTIFICATE (2)OP ID: RC AFRO CERTIFICATE OF LIABILITY INSURANCE D02/26/2015 ) o2/2s12o1 s 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 endorsement(s). PRODUCER PFS Insurance Group - JT 4848 Thompson Pkwy, Ste 200 Johnstown, CO 80534 Dave Janssen INSURED CA TESTCO, LLC GreenBack Operations, Inc. 1301 Academy Court Ft. Collins, CO 80524 CUSTOMER ID M: C'G RS--1 INSURER(S) AFFORDING COVERAGE NAI Admiral Insurance Company 24856 Hanover American Ins. Co. 36064 Allmerica Financial Benefit 41840 Pinnacol Assurance Co 41190 _ Zurich -American Ins Co. 116535 COVERAGES CERTIFICATE NIJMRFR• ol=vlQlnM Nu IaAMICID 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 TR TYPE OF INSURANCE AL. SUB DD POLICY EFF POLICY NUMBER MM/DD/YYYY POLICY EXP MM/DD/YYY1' LIMITS GENERALUABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY FEI-ECC-13290-01 03/01/2016 03/01/2016 DAWGE TO PREMISES Ea oNcunerXx $ 50,00 CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,00 A X BLANKET ADD'L INS 03/01/2015 03101/2016 PERSONAL SADVINJURY $ 1,000,00 X GENERAL AGGREGATE $ 2,000,00 A BLANKET WAIVER GERL AGGREGATE LIMIT APPLIES PER: POLICY X PRO- LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ C AUTOMOBILE LIABILITY ANY AUTO AW4-A232142 03/01/2015 03/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 X BODILY INJURY (Per person) III ALL OWNED AUTOS BODILY INJURY (Per accident) $ AUTOS i$1000 DIED COMP X PROSCHEDULED (PER ACTIDENT)DAMAGE (PER ACCIDENT) S C HIRED AUTOS 1$1000 DED COLL X $ C NON-OWNEDAUTOS C Blkt Al & Waiver X $ UMBRELLAU X OCCUR EACH OCCURRENCE $ 4,000,00 X AGGREGATE S 4,000,00 A EXCESS UAB CLAIMS�,fADE FEI-EXS-13291 03/01/2015 03l01/2016 DEDUCTIBLE $ X $ RETENTION $ 0 D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNCUTNE Y/N OFFICER/MEMBER EXCLUDED? DED? ❑ (Mandatory in NH) If yes. describe under N/A 4029480 CO WC4632690CA 01/01/2015 01/01/2015 01/01/2016 01/01/2016 X WC STATU- X OTH- EL. EACH ACCIDENT $ 1,000,00 E.L. DISEASE-EAEMpLovE $ 1,000,00 E.L. DISEASE -POLICY LIMIT i $ 1,000,00 DESCRIPTION OF OPERATIONS below _77FEI-ECC-13290-01 B Equipment Floater RZ4-A231842 03/01/2015 03/01/2016 Rented 200,00 A ,Pollution/Prof 03/01/2015 03/01/2016 Per claim 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) If reqquired 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 IJ 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD