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HomeMy WebLinkAbout133693 CGRS INC - INSURANCE CERTIFICATE (4)CGRSINC-01 LPREWITT .d►�o,Ro CERTIFICATE OF LIABILITY INSURANCE DATE 12/171201 YY) 12/17/2018 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: PFS Insurance Group REC PHONE FAX 4848 Thompson Parkway Suite 200 �1 V�I1 Arc, No, ExI : (970) 635-9400 (A/C, No):(970) 635-9401 Johnstown, CO 80534 D E DRE : info@mypfsinsurance.com J' INSURERS AFFORDING COVERAGE DEC 16 ilHQ _ INSURED City C G R S, Inc. & CA TESTCO, LLC anager'$ 0 fr�CO 1301 Academy Ct Fort Collins, CO 80524 r_r)%/FRAr_GC rc DYIENt'A Tc ul uIDCD. INSURERB:Allmerica Financial Benefit Insurance Company141840 INSURER C : Pinnacol Assurance Co 141190 INSURER E : INSURER F : ce THIS IS TO CERTIFY TI4AT 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. ILTR NSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSDEACH A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Blanket Add'I Insd FEI-ECC-13290-05 3/1/2018 3/1/2019 OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMI E Ea occurrence $ 50,000 X MED EXP An one person)$ 5,000 X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �X JEST 0 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOOpSWN AUTOS ONLY X A�TOS ONE Blanket Add] Insd X Blanket Waiver AW4A232142 3/1/2018 3/1/2019 COMBINEDSINGLELIMIT $ 1,000,000 X BODILY INJURY Perperson) $ BODILY INJURY Per accident $ X PROPER DAMAGE $ X A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE FEI-EXS-13291-05 3/1/2018 3/1/2019 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DIED I X I RETENTION $ 0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OMFFICER/MEMBER EXCLUDED? ( andatory in NH) If yec, Ascribe under DESCRIPTION OF OPERATIONS below N/A 4029480 1/1/2019 1/1/2020 X PER OTH- TAT TE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Leased/Rented Equip RH4A231842 3/1/2018 3/1/2019 $1,000 Deductible 200,000 A Pollution/Profession FEI-ECC-13290-05 3/1/2018 1 3/1/2019 iLimit Per Claim 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 8496 Compressed Natural Gas Fueling Facility, Design Build; Work Order #PR600097. If required by written contract he following provisions apply subject to the policy terms, conditions, limitations and exclusions: The City, its officers, agents and employees are included as Additional Insured on a Primary and Non -Contributory basis for ongoing and completed operations under General Liability and Automobile Liability. A Waiver of Subrogation applies to those named above for General Liability, Automobile Liability and Workers' Compensation. Umbrella is follow form. The insurance evidenced by this Certificate will not reduce coverage or limits and will not be cancelled, except after thirty (30) days written notice has been received by the City of Fort Collins. City of Fort Collins 300 Laporte Ave 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. REPRESENTATIVE AUUKU Lb (LU1b/U3) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD