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Home My WebLink About133693 CGRS INC - INSURANCE CERTIFICATE (12)---ON CGRSINC-01 LPREWITT ACORO F.ATE;MMIDDrYYYY) �� CERTIFICATE OF LIABILITY INSURANCE 1212/2017 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). CONTACT PRODUCER NAME:AX PFS Insurance Group 4848 Thompson Parkway Suite 200 (PAH1cN► o, Et): (970) 635-9400 (AJCC, No):(970) 635-9401 Johnstown, CO 80534 ADD E , info@mypfsinsurance.com INSURED C G R S, Inc. & CA TESTCO, LLC 1301 Academy Ct Fort Collins, CO 80524 INSURER A: Admiral Insurance Company 24856 INSURER B: Allmerica Financial Benefit Insurance Cornpany141840 INSURER c : Pinnacol Assurance Co 141190 INSURERO:The Hanover Insurance Company 122292 J INSU /�COTICIf�A TC KI raa000. DP%1lQlr1k1 NI IMRFR- v THIS• IS TOCERTIFYTHAT 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 LTRTYPE OF INSURANCE IN,, MD SUBR POLICY NUMBER POLICY EFF POLI pY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR Blanket Add'I Insd FEIECC1329004 03/01/2017 03/01/2018 DAMAGETO RENTED PREMISES ccurrence $ 50,000 X MED EXP (Any oneperson) $ 5,000 X Blanket Waiver PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. POLICY Lx] JECoT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY(CEO, a.,d.nlSINGLE LIMIT $ 1,000,000 BODILY INJURY Perperson) $ X ANY AUTO AW4A232142 03/01/2017 03/01/2018 BODILY INJURY Per accident OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY X Blanket Add'I Insd X Blanket Waiver $ PROPERTY DAMAGE Per accident $ _ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS -MADE FEIEXS1329104 03/01/2017 03/01/2018 X AGGREGATE $ 10,000,000 DED I X I RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A 4029480 01/01/2018 01/01/2019 OTH- PER I ER X I TAT TE E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT 11000,000 $ If yes describe under DESCRIPTION OF OPERATIONS below D Leased/Rented Equip RH4A231842 03/01/2017 03/01/2018 $1,000 Deductible 200,000 A Pollution/Profession FEIECC1329004 03/01/2017 03/01/2018 Limit Per Claim 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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. TIE 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) U 1938-2015 AGUKU cVKFUKAI IUN. An rignts reservea. The ACORD name and logo are registered marks of ACORD