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HomeMy WebLinkAbout303367 CLEAN ENERGY - INSURANCE CERTIFICATE (3)OP ID: RG ,d►�oR>o� CERTIFICATE OF LIABILITY INSURANCE DAT11/241YYYY) 1 /24/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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 endorsements . PRODUCER 310-356-8201 Dodge Insurance Services Inc. 310-316-1825 DBA: Arroyo Insurance Services 3510 Torrance Blvd., Suite 305 Torrance, CA 90503 Neil S Dodge NAME: CONTACT Rosemary Gomez AICNNo Ext :310-356-8218 A/c No): 310-316-1825 E-MAIL ADDRESS: rosemaryg@arroyoins.com PRODUCER CLEAN-1 CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # INSURED Clean Energy, A CA Corp. 3020 Old Ranch Parkway #400 Seal Beach, CA 90740 INSURER A: Federal Insurance Co 20281 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : .-nxiocAr_rc rP0TIPIreTI: Ni IMRF:P- REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_] OCCUR X DED BI/PD $100000 35816898 11/30/10 11/30/11 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 X., EMPLOYEE BENEFITS GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 1,000,00 Emp Ben $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Deductible $2500 73521989 73523633-MA 11/30/10 11/30/10 11/30/11 11/30/11 COMBINED SINGLE LIMIT accident) $ 1,000,00( X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ X $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 79860791 11/30/10 11/30/11 EACH OCCURRENCE $ 6,000,00 AGGREGATE $ 6,000,00 DEDUCTIBLE R—I'ENTiON i $ X A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 71736418 11/30/10 11/30/11 X TWOTH- SL M T DER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE -POLICY LIMIT $ 1, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Site #590 -117 N. Mason, Fort Collins, CO 80524 City's Director of Purchasing Risk Management 215 N. Mason 2nd Floor Fort Collins, CO 80524 L1AIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE � - zz - ©1988-2009 ACORD CVRPURA I IUN. All rlgnts reservea. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD