HomeMy WebLinkAbout114170 COCA-COLA BOTTLING CO GREELEY - INSURANCE CERTIFICATE (6)�® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
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 Beecher Carlson Insurance Services NAME: ATL Judith Boich
6 Concourse Parkway, Suite 2300 (AXJC N�Ext): (FAX,
No: 770.870.3031
Atlanta, GA 30328 E-MAIL
www.beechercarlson.com
INSURED
Coca-Cola Refreshments USA, Inc.
f/k/a Coca-Cola Enterprises Inc.
DBA Coca-Cola Bottling Co Greeley
1200 7th St
Greeley CO 80631
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CPRTIFICATF NIIMRFR• zGzrzzna
INSURER A: Ace American Insurance Company 22667
INSURERB: XL Insurance America, Inc. 24554
INSURER C: Indemnity Insurance Company of North America 43575
INSURER D: Agri General Insurance Company 42757
INSURER E : ACE Fire Underwriters 20702
INSURER F :
RFVISInN NLIMRFR
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
LTR
TYPE OF INSURANCE
ADDL
INSD
SUER
POLICY NUMBER
MMIDDY EFF
MD E'tP MM
LIMITS
A
�/
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F'/] OCCUR
HDO G27867406
5/1/2017
5/1/2018
EACH OCCURRENCE
$ 2,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence)
$ 50,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO JECT1:1 LOC
✓ POLICY E
OTHER:
GENERALAGGREGATE
$ 4,000,000
PRODUCTS - COMP/OP AGG
$ 5,000,000
$
B
AUTOMOBILE LIABILITY
✓ ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
RAD 943765504 (AOS)
5/1%2017
5/1/2018
Eaaccdent5wGLEUMIT
$ 5000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
C
A
D
E
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? ❑N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WLR C64410258 (AOS)
WLR C6441026A (AZ,CA,MA)
WLR C64410271 (TN)
SCFC64410283(WI)
5/1/2017
5!1/2017
5/1/2017
5/1/2017
5/1/2018
5/1/2018
5/1/2018
5/1/2018
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
A
Excess WC
(`GA, OH, WA)
WCU C64410295
5/1/2017
5/1/2018
'Statutory Excess of $1MM each accident
for listed states
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
1"a:A117Fh_\I=111;01 J--M
City of Fort Collins
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 q �},,
• "..`L ' i
Sharon D. Brainard
91988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
35353306 1 17-18 MASTER - OLD Standard I (ATL) Judith Boich 1 4/28/2017 8:10:30 PM (EDT) I Page 1 of 1