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Home My WebLink About303367 CLEAN ENERGY - INSURANCE CERTIFICATE (2)�Rbr CERTIFICATE OF LIABILITY INSURANCE OP ID RG DATE (MM/DD/YWY) CLEAN-1 11/25/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dodge Insurance Services Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DBA: Arroyo Insurance Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3510 Torrance Blvd., Suite 305 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Torrance CA 90503 Phone: 310-356-8201 Fax:310-316-1825 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A. Federal Insurance Co 20281 INSURER B. Clean Energy, A CA Corp. INSURER C: 3020 Old Ranch Parkway #400 INSURER D: Seal Beach CA 90740 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. IN5R LTR ADD'� INSR TYPE OF INSURANCE POLICY NUMBER DATLECMMIDDC/YYYY POLICY EXPIRATION DATE MM/DD YYYY LIMITS A GENERAL LIABILITY OMMERCIAL GENERAL LIABILITY CLAIMS MADE ® OCCUR #XDED BI/PD $100000 35816898 11/30/09 11/30/10 EACH OCCURRENCE $1,000,000 PREMISES(Ea occurence) $1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 % EMPLOYEE BENEFITS GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 71 POLICY PRO . JECT LOC PRODUCTS - COMP/OP AGG s2,000,000 Emp Ben. 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 73521989 73523633-MA 11/30/09 11/30/09 11/30/10 11/30/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS / UMBRELLA LIABILITY 1O OCCUR CLAIMSMADE pDEDUCTIBLE X RETENTION $ Q 35907415 11/30/09 11/30/10 EACH OCCURRENCE $ 6,000,000 AGGREGATE $ 6,000,000 $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below 71736418 11/30/09 11/30/10 A TWC LIMITS ER 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 / 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 80524 CERTIFICATE HOLDER CANCELLATION Trans Fort/Ft Collins City's Director of Purchasing & Risk Management 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 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) 1 The ACORD name and logo are registered marks of ACORD TION. All rights reserved. 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 This Certificate of Insurance 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 (2009/01) 7 ® DATE (MM/DD/YYYY) -� CERTIFICATE OF LIABILITY INSURANCE CPT.ID'.AN 1 11/24/09 Dodge Insurance Services Inc. DBA: Arroyo Insurance Services 3510 Torrance Blvd., Suite 305 Torrance CA 90503 Phone:310-356-8201 Fax:310-316-1825 INSURED Clean Energy, A CA Corp. 3020 Old Ranch Parkway #400 Seal Beach CA 90740 MOM=fA_1;eT*] 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 # INSURER A: Federal Insurance Co 20281 INSURER B: INSURER 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DDM'YOY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALLIAB!L!TY CLAIMS MADE ® OCCUR X DED BI/PD $100000 35816898 11/30/09 11/30/10 EACH OCCURRENCE $1,000,000 PREMISES(Eaocourence) $1,000,000 MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $1,000,000 X EMPLOYEE BENEFITS GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PEA LOC PRODUCTS - COMP/OPAGG $2,000,000 Emp Ben. 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 73521989 73523633-MA 11/30/09 11/30/09 11/30/10 11/30/10 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS / UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE X RETEN T ICiN $ 0 35907415 11/30/09 11/30/10 EACH OCCURRENCE $ 6 , OOO , OOO AGGREGATE $ 6,000,000 $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROP RIETOR/PARTNER/EXECUTIV� OFFICERAAEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below 71736418 11/30/09 11/30/10 A - - X TCRY LIMITS ER 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 / SPECIAL PROVISIONS *10 Days notice of Cancellation for Non Payment of Premium- RE: Site #590-117 N Mason Fort Collins, CO 80524 CERTIFICATE HOLDER CANCELLATION City's Director of Purchasing Risk Management 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 REPRESENTATIVES. UTHORIZED REPRESENTATIVE ACORD 25 (2009101) The ACORD name and logo are registered marks of ACORD TION. Ali rights reserved. 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 This Certificate of Insurance 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. AUURD Z5 (2009/01)