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HomeMy WebLinkAbout133693 CGRS INC - INSURANCE CERTIFICATE (5)CGRSINC-01 LPREW A�O,RO CERTIFICATE OF LIABILITY INSURANCE FD12/17/2018 ) 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 PFS Insurance Group 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 INSURED jac rio, EXg: (970) 635-9400 (A/c No):(970) 635-9401 ADDRESS: info@mypfsinsurance.com C G R S, Inc. & CA TESTCO, LLC INSURER C: 1301 Academy Ct INSURERD: Fort Collins, CO 80524 INSURER F : rica Financial Benefit Icol Assurance Co COVERAGES CFRTIFICATF NI IMRFR• DcvlclnKI uu IRA01=0. THIS !S TO CERTIFY THAT THE POLICIES OF INSURANCE LIFTED 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 POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR Blanket Add'I Insd FEI-ECC-13290-05 3/1/2018 3/1/2019 EACH OCCURRENCE $ 1,000,000 DAMAGET RENT ante $ 50,000 X MED EXP (Any oneperson) $ 5,000 X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑X JERCOT- LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER. B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NONOWNEDPROPERTY AUTOS ONLY AUTOS ONLY BlanketAdd'I Insd X Blanket Waiver AW4A232142 3/1/2018 3/1/2019 Ea aBINEDtSINGLE LIMIT $ 1,000,000 X BODILY INJURY Per person $ BODILY INJURY Per accident $ X DAMAGE Per accident $ 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 $ O C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A 4029480 1/1/2019 1!1/2020 X PER OTH- AT T 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 3/1/2019 Limit Per Claim 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mole space is required) RE: 8646, CNG Site Maintenance Contractor 2018. If required by written contract the 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. I,.CR I Ir i,-A I C MULUtK CANCELLATION City of Fort Collins Attn: Purchasing Dept 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 AUUKU Lb (2U'IbIUZJ ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD