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HomeMy WebLinkAbout133693 CGRS INC - INSURANCE CERTIFICATE (7)---'� CGRSINC-01 LPREW ACORO CERTIFICATE OF LIABILITY INSURANCE FDATE (MM/DD YYYY) � 2/27/2019 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 riqhts to the certificate holder in lieu of such endorsement(s). PRODUCER PFS Insurance Group 4848 Thompson Parkway Suite 200 Johnstown, CO 80534 INSURED C G R S, Inc. & CA TESTCO, LLC 1301 Academy Ct Fort Collins, CO 80524 COVERAGES CERTIFICATE NUMBER: rnvn� (A/c, No, Ext): (970) 635-9400 lac, No):(970) 635-9401 ADDAIL • info@mypftinsurance.com INSURERS AFFORDING COVERAGE NAIC INSURER A: Admiral Insurance Company 24856 INSURER B : Allmerica Financial Benefit Insurance Company 41840 INSURER C : Pinnacol Assurance Co 41190 INSURER D : The Hanover Insurance Company 22292 INSURER E : INSURER F : REVISION NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP_LTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXJ OCCUR FEIECC1329006 3/1/2019 3/1/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMI E Ea occurrence 60,000 $ X MED EXP (Any oneperson) $ 5,000 Blanket Add'I Insd _ X PERSONAL&ADV INJURY $ 1,000,000 Blkt Waiver of Subo GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �X P LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident)X $ 1,000,000 BODILY INJURY Perperson) $ _ $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AW4A232142 3/1/2019 3/1/2020 BODILY INJURY Per accident X PROPERTY DAMAGE .cadent $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY(Par Blanket Addl Insd X Blkt Waiver of u ro X $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 ESS LIAB CLAIMS -MADE FEIEXS1329106 3/1/2019 3/112020 $ DECDI X I RETENTION $ 0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ �NlandatoryinNH)EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS bel N/A 4029480 1/1/2019 1/1/2020 i X I SPER TATUTE ORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. UISEASE -POLICY LIMIT 1,000,000 1 $ p Leased/Rented Equip RH4A231842 3/1/2019 3/1/2020 $1,000 Deductible 200,000 A Pollution/Profession FEIECC1329006 3/1/2019 3/1/2020 Limit 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD