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HomeMy WebLinkAboutBLUE ENERGY TECHNOLOGIES - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MM/DDIYYYY) PIC230A 11 23 04 PRODUCER THIS CERT Dodge Warren 6 Peters -Torrance IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lic. #0543895 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3625 Del Amo Blvd., #300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Torrance CA 90503- Phone:310-542-4370 Fax:310-542-1803 INSURERS AFFORDING COVERAGE NAIC# INSURED Blue Energy & Technologies,LLC INSURER A: Federal Insurance Company Natural Fuels Clean Enery Fuels INSURER B: Great American Ins. companies Barbara Johgnson INSURER C 3020 Old Ranch Pk , STE ZOO Seal Beach CA 90740 INSURER D. INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDIYY DATE MMIDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X I COMMERCIAL GENERAL LIABILITY 35816898 11/30/04 11/30/05 PREMISES (Ea occurence) $ 100,000 CLAIMS MADE LX OCCUR 7— MED EXP(Any one person) $ 10,000 - PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 POLICY PRO- JECT X LOC AUTOMOBILE LIABILITY A ANY AUTO 73521990 11/30/04 11/30/05 COMBINED SINGLE LIMIT (Ea accident) $ 1 OOO ,000 X ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIREDAUTOS X NON-OWNEDAUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 B X OCCUR �CLAIMSMADE TUU3579326 11/30/04 11/30/05 AGGREGATE $10,000,000 DEDUCTIBLE RETENTION $N/A $ WORKERS COMPENSATION AND X___ TORY LIMITS ER A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 71710119 11 /30/04 11/30/05 E.L. EACH ACCIDENT Is 1 000 000 OFFICERIMEMBER EXCLUDED? E. L. DISEASE -EA EMPLOYEE $1 OOO OOO I( yes, describe under E.L. DISEASE -POLICY LIMIT I $1 000 000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *10 days notice IF for non-payment of premium. CITY OF FORT COLLINS IS ADDITIONAL INSURED BY CONTRACT FOR SERVICES AGREEMENT - CNG FUELING FACILITY AT FORT COLLINS, CO. _—......—.. • — • •--��• • liM1Yl.CLLX I IVIY C-FTCOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF FORT COLLINS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL * 30 DAYS WRITTEN PURCHASING NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ATTN: JAMS B. O'NEILL II P.O. BOX 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR FORT COLLINS CO 80522 REPRESENTATIVES. ACORD 25 (2001/08) ©ACORD CORPORATION'1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. nrnRn ?n onnum