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CGRSINC-01 LPRE ITT
<br /> ,d►�JRn CERTIFICATE OF LIABILITY INSURANCE GATE 7/2!
<br /> 1 2111 712 01 1 8 8
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
<br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endomement(s).
<br /> PRODUCER
<br /> CONTACT
<br /> PFS Insurance Group PHONE FAx
<br /> 4848 Thompson Parkway Suite 200 (AIC,No,Eat):(970)635-9400 (AIC,N,):(970)635-9401
<br /> Johnstown,CO 80534 E DARE .info@mypfsinsurance.com
<br /> INSURER(S)AFFORDING COVERAGE NAIC p
<br /> INSURER A:Admlral Insurance Company 24856
<br /> INSURED INSURERB:AIImerlca Financial Benefit Insurance Company 41840
<br /> C G R S,Inc.&CA TESTCO,LLC INSURER C;Zurich American Insurance Co 16535
<br /> 1301 Academy Ct INSURER D:The Hanover Insurance Company 22292
<br /> Fort Collins,CO 80524
<br /> INSURER E
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HLREIN 1.5 SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br /> -
<br /> INSR ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP tNSD MVD LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000'000
<br /> CE.-41M5-MADE FX OCCUR FEI-ECC-13290-05 31112Dt8 3/112019 DAMAGE TO RENTED f 550,000
<br /> X Blanket Add'I Insd 5,000
<br /> MED EXP An one ,son $
<br /> X Blanket Waiver PERSONAL 8 ADV INJURY S 1'000'000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2'000,000
<br /> POLICY FA] Poe, ❑LOC PRODUCTS-COMPIOP A f 2,000,000
<br /> OTHER' S
<br /> B AUTOMOBILE LIABILITYCOMBIN En SINGLE LIMIT $ 1,000,000
<br /> X ANY AUTO W4A232142 3/1/2018 3/112019 BODILY INJURY Per erson $
<br /> OWNED SCHEDULED
<br /> AUTOS ONLY AUTOS BODILY INJURY Per accident 5
<br /> X HIRED X N10N-oWNED POPE% DAMAGE
<br /> AUTOS ONLY AUTOS ONLY er accident $
<br /> X Blanket Addi Insd X Blanket Waiver
<br /> f
<br /> A X UMBRELLA LIABX OCCUR EACH OCCURRENCE f 10,000,000
<br /> EXCESS UAB CLAIMS-MADE FEI-EXS-13291-05 3/1/2018 31112019 AGGREGATE 10,000,000
<br /> DED X RETENTION$ 0
<br /> C WORKERS COMPENSATION X PER OTH.
<br /> AND EMPLOYERS'LIABILiTVFI?
<br /> ANY PR OPRIETORlPARTNERIFxECUTIVE Y 04632690-08 111/2019 1!112020 1,000,000
<br /> OFFICERIMF,MWgR EXCLUDED? 1-1 WA E.L.EACH ACCIDENT $
<br /> (Mantl.I." NH) E.L.DISEASE-EA EMPLOYE f 11000,000
<br /> If yes,describe under 11,000,0_00
<br /> DESCRIPTION OF OPFRATICNS below EL DISEASE-POLICY LIMIT $
<br /> D Leased/Rented Equip RH4A231842 311/2018 311/2019 $1,000 Deductible 200,000
<br /> A Pollution/Profession FEI,ECC-13290-05 311/2016 311/2019 Limit Per Claim 1,000,000
<br /> DESCRIPTION OF CPERATIONS f LOCATIONS I VEHICLES (ACORO 101,AdditionaT Remarks Schedule,maybe attached It more space is required)
<br /> If required by written contract,the Certificate Holder is included as Additional Insured for ongoing operations under General Liability.
<br /> CERTIFICATE!-FOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> ley Pacific Petroleum Services THE EXPIRATIO
<br /> ValN DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Val Frank West Circle ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Stockton,CA 95206
<br /> AUTHORIZED REPRESENTATIVE
<br /> ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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