HomeMy WebLinkAboutSLE SOURCE ENERGY SOLUTIONS - INSURANCE CERTIFICATEOP ID TH
AC CERTIFICATE OF LIABILITY INSURANCE sOD TH
DATE (MM/DDMYY)
02/11/09
PRODUCER
Colorado Insurance
Professionals, Inc.
2241 S . Peoria St., Ste. 209
Aurora CO 80014-1100
Phone: 303-755-8600 Fax: 303-755-2516
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Sol Source Energy Solutions
6820 N Broadway Unit A
Denver CO 80221
INSURER A: Auto Owners Insurance
18988
INSURERB: Pinnacol Assurance
41190
INSURER C:
INSURERD:
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.
LTR
NSR
TYPE OF INSURANCE.
POLICY NUMBER
DATE (MM/0D/Y1')
DATE (MM/DD/YY)
LIMBS
GENERAL LIABILITY
EACH OCCURRENCE
$ $1,000,000
A
X COMMERCIPLGENERAL LIABILITY
74422361
10/16/08
10/16/09
PREMISES cc (Eaourence)
$ $300,000
CLAIMS MADE � OCCUR
MED EXP (Any one person)
$ $10 , 000
PERSONAL & ADV INJURY
$ $1,000,000
GENERAL AGGREGATE
$ $2 , 000 , 000
GEN'LAGGREGATE LIMIT APPLIES PER :
PRODUCTS - COMP/OPAGG
$$2,000,000
POLICY X jET LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$$1,000,000
A
X
ANY AUTO
4742236100
10/16/08
10/16/09
(Ea accident)
BODILY INJURY
$
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
BODILY INJURY
$
HIRED AUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$ $1,000,000
A
X OCCUR 1-1 CLAIMS MADE
47422361
10/16/08
10/16/09
AGGREGATE
$$1,000,000
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
TORY LIMITS I X ER
B
EMPLOYERS' LIABILITY
41185i2
i� �?-
�/.,1/_
il, 01/09
E.!.,EACHACCIDENT
$ $1,0001.000
ANYPROPRIETOR/PARTNER/EXECUTIVE
LE . DISEASE - EA EMPLIYEEj
$$1,000,000
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT 1
$ $1,000,000
OTHER
A
Auto Owners
4742236100
10/16/08
10/16/09
Comp Ded $500
Coll Ded $500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Ten day notice of cancellation for nonpayment of premium.
CERTIFICATE HOLDER CANCELLATION
CITYOFF 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
City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. BOX 580 REPRESENTATIVES.
Ft. Collins CO 80522-0580 AUTH BiiEPRESENTATIVE
/At.VR V LJ (LUU'I/US) v ra.Vrnv 4.VnrvnM 11W11 1a00
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 25120011021