HomeMy WebLinkAbout399052 ENERGYLOGIC INC - INSURANCE CERTIFICATE�i a
CERTIFICATE OF LIABILITY INSURANCE
DATE(mmlDDmrr)
09/17/2012
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 POLICIE
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
._. _ ... _ 9 -.
the termsandcondi[ions of the. policy, certain policies may require an endorsement. A statement on this certificate does'not confer rights the
certificate holder in lieu of such endorsement
-
PRODUCER
Lockton Risk Services
P.O. Box 410679
_
CONTACT _
NAME:
_
PHONE 800-806-0263 - FAX
INC. No. Est)Run Not
E-MAI
ADDREL SS:
INSURER(SI AFFORDING COVERAGE
NAICN
Kansas City, MO 64141-067T9
INSURER A Hartford Casualty Insurance Company
29424
INSURED j
INSURER B
INSURER c
EnergyLogic, ITC.
INSURER D
PO Box N
525 E Cty Rd (Hwy 56)
INSURER
Berthoud, CO 60513
INSURER F
ETiorATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO
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 TERM
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
AODL
INSR
SUER
WVQ
POLICY NUMBER
POLICY EFF
IMMIDINYYYY1
POLICY EXP
(IMMIDEVY)YR)
LIMITS
A
GENERAL LIABILITY
X
37SBAARG056-06
10/20/2012
10/20/2013
I EACH OCCURRENCE
S 2,000,000
DAMAGE TO RENTED
c
PREMISES !Ea oc
S 300, 000
GENERAL LIABILITY
MED EXP(Any one person)
S 10, 000
CLAIMS MADE X IOCCUR
PERSONAL B AOV INJURY
5 2,000,000
TXCOMMERCIAL
GENERAL AGGREGATE
S 4, 000, 000
GEN'L AGGREGATE LIMIT APPLIES
X .POLICY PRO-LOC.
PER'.
PRODUCTS - COMPIOP AGO
$ 41, 000, 000
COMBINED SINGLE LIMIT
-
AUTOMOBILE LIABILITY
-
L(Ea accident
S
ANYAUTO
ALL OWNED SCHEDULED
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
S'
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Per accident
S
5
UMBRELLA LIAB
EACH OCCURRENCE
S
S
(OCCUR
EXCESS LIAB I I
CLAIMSMADEAGGREGATE
DED I I RETENTION S
S
WORKERS COMPENSATION
WC STAID I OIN
AND EMPLOYERS' LIABILITY N
ANY PROFRIEFOR/PARTIJERIEXEGJTI'!(1--I
OFFICERIMEMBER EXCLUDED? a
(Mandatory in NH)
NIA
-
-.'_ EACH ACCIDENT
S
E.L. DISEASE - EA EMPLOY
E.L. DISEASE POLICY LIMIT
8
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remark. Schadule, if mare apace ie required)
Certificate Holder is listed as Additional Insured to the General Liability as respects to work performed by Named Insured
per Hartford Policy Form SS 00 08 04 05.
CANICFI I ATION
City of Fort Collins
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
215 N Mason Street
ACCORDANCE WITH THE POLICY PROVISIONS.
DO Box 580
AUTHORIZE REPRESENTATIVE
Fort Collins, CO 80522
(__� Rj98_�,2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
10413683 990567