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Home My WebLink About133693 CGRS INC - INSURANCE CERTIFICATE (10)CGRSINC-01 LPREWITT ACORO CERTIFICATE OF LIABILITY INSURANCE FDATE (27/2 Y01 02/8 � /8 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 (A/c, No, EXt): (970) 635-9400 (A/C, No):(970) 635-9401 Johnstown, CO 80534 ADDRESS, info@mypfsinsurance.com INSURED C G R S, Inc. & CA TESTCO, LLC 1301 Academy Ct Fort Collins, CO 80524 A:Admiral Insurance Company B:Allmerica Financial Benefit Insurance c : Pinnacol Assurance Co RER F : CnVFRAGFR CFRTIFICATF NI IMRFR• RFVISInN NI IMRFR- FZ,I.M.1 !TEP111 T HIS 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 SUER POLICY NUMBER POLICY EFF POLICY EXPLTIR LIMITS A X COMMERCIAL GENERAL LIABILITY J CLAIMS -MADE [X]OCCUR FEI-ECC-13290-05 03/01/2018 03/01/2019 EACH OCCURRENCE $ 1,000,000 DAM AGE TO RENTED PR MI E Ea occurrence SO,000 $ X MED EXP (Any oneperson) $ 5,000 Blanket Add'I Insd X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �X PEef LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident 1,000,000 $ X BODILY INJURY Perperson) $ ANY AUTO AW4A232142 03/01/2018 03/01/2019 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X PROPERTY DAMAGE Peraca l $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE FEI-EXS-13291-05 03/01/2018 03/01/2019 DIED I X I RETENTION $ O C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N Mandatory in NHR EXCLUDED? N/A 4029480 01/01/2018 01/01/2019 X I PER OTH- TAT R E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE 1,000,000 $ If yes. describe under GE SCRIPTIOIv Or OPERATIONS below E.L. DISEASE -POLICY LIMIT 1,000,000 D Leased/Rented Equip RH4A231842 03/01/2018 03/01/2019 $1,000 Deductible 200,000 A Pollution/Profession FEI-ECC-13290-05 03/01/2018 03/01/2019 Limit Per Claim 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 8496 Compressed Natural Gas Fueling Facility, Design Build; Work Order #PR600097. If required by written contract or written agreement 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 for ongoing and completed operations under General Liability and Designated Insured under Automobile Liability (except Hired and Non -Owned Automobile). A Waiver of Subrogation applies to those named above for General Liability, Automobile Liability and Workers' Compensation. Umbrella is follow form. This insurance will apply on a primary, non-contributory basis. 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 LOY-10 Le 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