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HomeMy WebLinkAbout114170 COCA-COLA REFRESHMENTS USA INC - INSURANCE CERTIFICATE (2)ACOKO� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YVYY) 4/28/2015 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 Beecher Carlson Insurance Services 6 Concourse Parkway, Suite 2300 Atlanta, GA 30328 CONTCT NAME' Beecher Carlson Insurance Services IPA ,N 678-539-4800 Fvc No): 770-870-3031 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURERA: Ace American Insurance Company 22667 WWW. beechefcaflson. COm INSURED Coca-Cola Refreshments USA, Inc. f/k/a Coca-Cola Enterprises Inc. DBA Coca-Cola Bottling Co Greeley INSURER B: XL Insurance America Inc. 24554 INsuRERc: Indemnity Insurance Company of North America 43575 INSURER D: Agri General Insurance Company 42757 1200 7th St Greeley CO 80631 INSURERE: ACE Fire Underwriters 20702 INSURER F: COVERAGES CERTIFICATE NUMBER: 24432030 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURFn 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 UBR POLICY NUMBER POLICY EFF MM/DD/VYYY POLICY EXP MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑✓ OCCUR 7 HDOG27394024 5/1/2015 5/1/2016 EACH OCCURRENCE $ 2,000,000 PREMI E TOR a umence $ 50,000 MED EXP (Any one rson) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. ✓ POLICY O PRO- JECT LOC OTHER: GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OPAGG $ 5,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NONAWNED AUTOS RAID 943765502 (AOS) 5/1/2015 5/1/2016 COMBINEDSINGLE LIMIT$ 5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident) $ S UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DIED I I RETENTION$ $ C A D E WORKERS COMPENSATION AND EMPLOYERSLIABILITY ' r/N OFFICER/MEM ER EXCLUDED PROPRIETOR/PARTNER/EXECUTIVEANY � (Mandatory in NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below NIA WLR C4815170A(AOS) WLR C48151711(AZ,CA,MA) WLR C48151723 (TN) SCF C48151735 (WI) 5/1/2015 5/1/2015 5/1/2015 5/1/2015 5/1/2016 5/1/2016 5/1/2016 5/1/2D16 ✓ STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A !(GA. Excess WC LA. MI. OH. OK. OR. WA) WCU C48151693 WPM 5/1/2016 Statutory Excess of $1MM each accident for listed states except MA -Statutory Excess of $500,000 for each accident DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES IACORD 101, Additional Remarks Schedule, may be attached If more space is required) �rN 111-1 wM I a nVLumm I AIYI.CLLA I IUIN 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 Sharon D. Brainard © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 24432030 IATL) Candi Joyner 4/28/2015 3:20:16 PM (EDT) Page 1 Of 1