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HomeMy WebLinkAbout303367 CLEAN ENERGY - INSURANCE CERTIFICATEcnanf$•2QA1n rr MAu ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY) 11/26/08 PRODU:ER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dodge Insurance Svcs (310) 356-8201 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Arroyo Insurance SvcsFax (310) 316.1825 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3510 Torrance Blvd. Suite 305 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Torrance, CA 90503 INSURERS AFFORDING COVERAGE NAIC # INSURED Clean Energy, A CA Corp INSURER A. Federal Insurance Company 3020 Old Ranch Parkway #200 INSURER B:INSURER Seal Beach, CA 90740 C: 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, S LTR ADD NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY POLICY EXPIRATION DATE MMIDD/YY LIMITS A GENERAL LIABILITY 35816898 11/30/08 11/30/09 EACH OCCURRENCE $1000000 X DAMAGE TO RENTED PREMISES (Pa occur,oneal $1 QQQ QQQ A A COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR MED EXP (Any one person) $10 000 X PERSONAL & ADV INJURY $1 Q0O QQQ BI/PD Ded:100000 GENERAL AGGREGATE s2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO - ECT LOC PRODUCTS - COMP/OP AGG s2000000 A A AUTOMOBILE X LIABILITY ANY AUTO 73523633 73521989 11/30/08 11/30/08 11/30/09 11/30/09 COMBINED SINGLE LIMIT (Ea accident) $1'QQQ QQQ ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY (Per person) $ HIREDAUTOS X NON-OWNEDAUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO R $ AUTO ONLY: AGO A LIABILITY OCCUR CLAIMS MADE 79860791 11/30/08 11/30/09 EACH OCCURRENCE $6000000 AGGREGATE $ $ NESSIUMBRELLA $ DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 71736418 11/30/08 11/30/09 X WC STATU- OTH- IMITS FIR E.L. EACH ACCIDENT $1,000000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $1 ,000,000 E.L. DISEASE -POLICY LIMIT $1 OQQ,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *10 Days Notice of Cancellation for Non Payment of Premium. RE: Site #590 - Trans Fort/Ft. Collins -117 N. Mason, Fort Collins, CO Trans Fort/Ft. Collins City's Director of Purchasing & Risk Mgmt 215 N. Mason, 2nd Floor Fort Collins, CO 80524 THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *fin DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE ACORD 25 (2001108) 1 of 2 #S55398/M55257 ROS © ACORD CORPOR/ 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. MVVRV LVV 1GVV 1/VOr z Otz 8555398/M55257 ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY) 11 /26/08 I aRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dodge Insurance Svcs (310) 356-8201 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Arroyo Insurance SvcsFax (310) 316-1825 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3510 Torrance Blvd. Suite 305 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Torrance, CA 90503 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Federal Insurance Company Clean Energy, A CA Corp 3020 Old Ranch Parkway #200 INSURER B: Seal Beach, CA 90740 INSURER C: INSURER D: 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 NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DDIYY POLICY EXPIRATION DATE MM/DDIYY LIMITS A A A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE 51OCCUR BI/PD Ded:100000 35816898 11/30/08 11/30/09 RENCE $1000000 ENTED $1 000 000 y one person) $10 000X ADV INJURY MT $1 000 000GREGATE $2 000 000GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT 7 LOC COMPIOP AGO $2 000 000 A A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS 73523633 73521989 11/30/08 11/30/08 11/30/09 11/30/09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ X X BODILY INJURY (Peraccident) $ X PROPERTY DAMAGE (Per accident) $ A GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY X OCCUR 1:1CLAIMS MADE DEDUCTIBLE RETENTION $ 79860791 11/30/08 11/30/09 AUTO ONLY - EA ACCIDENT $ OTHERTHAN EA ACC AUTO ONLY: AGG EACH OCCURRENCE $ $ s6,000,000 AGGREGATE $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Oyes,c / uncleSER EXCLUDED' If yes, tlescribe under SPECIAL PROVISIONS below 71736418 11/30/08 11/30/09 X WC STATU OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE EA EMPLOYEE $1,000,000 E.L. DISEASE POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *10 Days Notice of Cancellation for Non Payment of Premium. RE: Site #590 - Trans Fort/Ft. Collins - 117 N. Mason, Fort Collins, CO Trans Fort/Ft. Collins City's Director of Purchasing & Risk Mgmt 215 N. Mason, 2nd Floor Fort Collins, CO 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30, DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001108) 1 of 2 $S953Rd/MAR9G7 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. ^�� .� --'—v „—, c or A 8Ab03S4/M*0Z0f