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Home My WebLink AboutBLUE ENERGY TECHNOLOGIES - INSURANCE CERTIFICATE (3)•' ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID C DATE (MMIDDIYYYY) PIC230A 12 23 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dodge Warren & Peters -Torrance 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 INSURERA: Federal Insurance Com an Blue Energy & Technologies,LLC INSURER B: Great American Ins. Cmpanies Natural Fuels INSURER C: Barbara Johnson 3020 Old Ranch Pkjwy, STE 200 INSURER D: Seal Beach CA 9074D INSURER E: COVERAGES 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. INbKV0 LTR rSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMKIDIYY POLICY EXPIRATION DATE MWDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X❑ OCCUR 35816898 11/30/03 11/30/04 EACH OCCURRENCE $ 1,000,000 PREMISES(Ee occurence) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL 3ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: 17 POLICY 7 jE0 X LOC PRODUCTS - COMPIOP AGG $ 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON-OWNEDAUTOS 73521990 11/30/03 11/30/04 COMBINED SINGLE LIMIT (Ea accident) E 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ B EXCESSIUMBRELLA LIABILITY X OCCUR CLAIMSMADE DEDUCTIBLE RETENTION $N/A TUU3579326 11/30/03 11/30/04 EACH OCCURRENCE $ 10,000,000 AGGREGATE $10,000,000 $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? Use, describe under SPECIAL PROVISIONS below 71710119 11/30/03 11/30/04 OTH X TORY LIMITS ER E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $ 1 000 000 E.L. DISEASE -POLICY LIMIT I $1 000 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *10 days notice IF for non-payment of premium. CITY OF FORT COLLINS IS NAMED ADDITIONAL INSURED BY CONTRACT FOR SERVICES AGREEMENT - CNG FUELING FACILIT Y AT FORT COLLINS, CO. CERTIFICATE HOLDER CITY OF FORT COLLINS PURCHASING ATTN: JAMES B. O'NEILL II P.O. BOX 580 FORT COLLINS CO 80522 C-FTCOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL BQQXMAIL * 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT IWALM111000 70[SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. 1 ' ACORD 25 (2001/08) 0 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. ACORD 25 11-23-03 04:51pm From- +310 542 1803 T-598 P.002/003 F-984 ACPM. CERTIFICATE OF LIABILITY INSUKANU: :�IOPID U R 1z z3 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF WFORMATION Dodge Warren & Peters -Torrance 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 8YTHE POLI'',IESBELOW. Torrance CA 90503- Phone: 310-542-4370 Fax: 310-542-1803 INSURERS AFFORDING COVERAGE NAIL 0 INSURED INSURER& Federal Insurancla Company Blue Energy & Teehnologi.es,LLC I INSURERS: a mt AMFLG'R TAR. C VARLIa Natural Fugis Sarbat'a Johnson INSURER C; 3020 Old Ranch Pkwv, STE 200 INSURER0: Seal Beach CA 9074 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWTITISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCEAFFOROED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L N TYPE OP IN POLICY HUBEI DATE@EEMDA B LA_ YTS A GENERAL LIABILITY X COMMERCIAL GENERAL LIASILnY CLAIMS MADE OCCUR 35816898 11/30/03 11/30/04 EACH OCCURRENCE s 1 000,000 _ PREMISES EsaccV,o cR' S 100,000 MED EXP' kw one pmw) $ 10 000 PERSON,%L S ADV INJUR!_ s 1 000 000 GENERA.AGGREGATE S 2,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY CCT X LOC PRODUCES-C6MP/OPA(1G S 1,000 000 A AUTOMOBILE LABILITY ANY AUTO ALL OWNED AUTOS SCHEOULEDAUTOS HIREOAUTOS NON -OWNED AUTOS 73521990 11/30/03 11/30/04 COMBINEID SINGLE LIMIT1,000,000 (Eeama,lml s X SOOILY INJURY (PcrPerom) S X SOOILYINJURY (Pafaod"m S X PROPERTYDAMAGE (Par mccidbn0 S GARAGE NUBILITY ANYAUTO AUTO ONLY -EA ACCID13IT S OTHERIHAN EA.L-C AUTO OHLY: .A30 s S 8 MESSNMBRELLA LIABILITY X OCCUR mmmswm DEDUCTIBLE RETENTION sN/A TUU3379326 11/30/03 11/30/04 EACH OCCURRENCE S 10 , 000 000 _ AGGREGATE s 10 000 000 s - S S A WORKERS COMPENSATION AND EMPLOYERS'LIABMY ANY PROPRIETORIPARTNERIEXECUTNE OFFICERNAEMBER EXCLUDED? tt yea, aemibs undx SPECIAL PROVISIONS IMew i1710119 11 30 / /03 11/30/04 X TORYLIMITS LW. GR F-LEACHACCIDENT sl 000 000 EL OIS[ASE-EA EMPL:YE B 1 000 000 E.L. DISEASE. POLICY I. GAIT sl 000 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BY FACCIRSEMSNT I SPECIAL PROVISIONS - *10 days notice IF for AOn-payment of premium. CITY OF FORT COLLINS IS )UUM ADDITIONAL INSURED BY CONTRACT FOR SERVICES AGREEGM - CNG FUELING FAC:ILIT Y AT FORT COLLINS, CO. CITY OF FORT COLLINS PURCHASING ATTN: a7AbbMS B. OINLILL II P.O. HOX 580 FORT COLLINS CO 80522 C-FTCOL I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL LED BEFORE YHE EXPIRATION DATE THILRDOP, THE IMBUING INSURER TALL UfMWMCIMMW JL *30 DATSWRmmN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, B JT SERVES SMALL IMPOSE NO OBLIOATION OR LIABILITY OF ANY KIND UPON YH S INSURER ITS AGENTS OR k -N r