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HomeMy WebLinkAbout133693 CGRS INC - INSURANCE CERTIFICATE (8)CGRSINC-01 LPREWITT ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 212712019 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 PHONE FAX 4848 Thompson Parkway Suite 200 (AIC, No, Ext): (970) 635-9400 (ac, No):(970) 635-9401 Johnstown, CO 80534 EADDRESS: info@mypfsinsurance.com INSURED C G R S, Inc. & CA TESTCO, LLC 1301 Academy Ct Fort Collins, CO 80524 A: Admiral Insurance Com R- Allmerica Financial Bene 24856 INSURER D : The Hanover Insurance Companv 122292 I rnVFRAnFA CFRTIFICATF NI IMRFR• RFVILQII)N NI IMRFR• TI ;:S IS TO CERTIFY THAT THE POLICIES' OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY" FERiOD 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 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR Blanket Add'I Insd FEIECC1329006 3/1/2019 3/1/2020 DAMAGE TO RENTED PREMISES a occurrence 50,000 $ X MED EXP (Any oneperson) $ 6,000 X Blkt Waiver of Subo PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑X JE LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY COMEa.1 NED SINGLE LIMIT $ 1,000,000 X BODILY INJURY Perperson) $ ANY AUTO AW4A232142 3/1/2019 3/1/2020 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS X PROPERTY DAMAGE Per accident $ HIRED X NUT16STED AUTOS ONLY AUTOS ONLY Blanket Add] Insd X Blkt Waiver of Subro X A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESSLIAB CLAIMS -MADE' FEIEXS1329116 3/1/2019 3/1/2020 DED X RETENTION $ 0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY v/N ANY PROPRIETOR/PARTNER/EXECUTIVE FICER/WMEMBER EXCLUDED? andatory in NH) N/A 4029480 1/1/2019 1/1/2020 X PER OTH- TAT T E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIF TION CF OP -_RATIONS below 1,00f),OOf)1 5 E.L. DISEASE - POLICY LiMI1 D 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 I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more 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. 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 zo-fi.- ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD