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HomeMy WebLinkAbout303367 CLEAN ENERGY - INSURANCE CERTIFICATE (5)CLEAN-1 OP ID: LM '`'�� CERTIFICATE OF LIABILITY INSURANCE DAT11129/12vv) F 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 Phone:310-356-8201 Dodge Insurance Services Inc. Fax: 310-316-1825 DBA: Arroyo Insurance Services 3510 Torrance, CA 90503 Torrance Blvd., Suite 305 Torr Neil S. Dodge .� � CONT T Rosema Gomez PHONE 310-356-8218 nIc Na: 310-316-1825 AIC No Ex[: EMAIL ADDREss: rosema arro oins.com INSURERS AFFORDING COVERAGE NAIC k INSURER A: Federal Insurance Co 20281 VVVV INSURED Clean Energy, A CA Corp. 3020 Old Ranch Parkway #400 Seal Beach, CA 90740 INSURER B: 'INSURER C: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE 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 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 ADDL SUB POLICY NUMBER POLICY EFF MMIDDYYYY POLICY EXP MM IDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX I OCCUR X Ded BI/PD $100000 35816898 11/30/12 11/30/13 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 10,00 PERSONAL BADV INJURY $ 1,000,00 X Employee Benefits GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER'. POLICY PRO LOC X PRODUCTS - COMPIOP AGG $ 1,000,00 Emp Ben $ 1,000,00 A AUTOMOBILE LIABILITY X ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS X Phy Damage Ded $2,500 73521989 11/30/12 11/30/13 COMBINED SINGLE LIMIT Ea accident)$ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per acrodent) $ PROPERTY DAMAGE Per accitlent $ Auto Liab Ded $ 5,00 A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE 79860791 11/30/12 11/30/13 EACH OCCURRENCE $ 6,000,00 AGGREGATE $ 6,000,OD DED I X I RETENTION None $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIE%ECUTIVEYIN OFFICERNEMBER EXCLUDED' N I (Mandatory In NH) If yes, 0 scribe under DESCRIPTIONOFOPERATIONSbelew NIA 71736418 11/30/12 11/30/13 X WC STATU- OTH- T IMI EL EACH ACCIDENT $ 1,000,00 EL DISEASE -EA EMPLOYEE $ 1,000,00 — -- EL. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 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 REPRESENTATNE _W 1.b ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) - The ACORD name and logo are registered marks of ACORD CLEAN-1 OP ID: LM ,akieli CERTIFICATE OF LIABILITY INSURANCE DATE DIYYYV) 11/29/12 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 Phone:310-356-8201 Dodge Insurance Services Inc. Fax: 310-316-1825 DBA: Arroyo Insurance Services 3510 Torrance Blvd., Suite 305 Torrance, CA 90503 Neil S. Dodge NAORVCT RosemaryGomez PNONE 310-356-8218 aIc Nob 310-316-1825 A/C No Ext: E-MAIL rosema arro oins.com ADDRESS: INSURERS AFFORDING COVERAGE NAIL# INSURER A: Federal Insurance Co 20281 INSURED Clean Energy, A CA Corp. 3020 Old Ranch Parkway #400 Seal Beach, CA 90740 INSURER B: INSURERC: INSURER D : INSURER E : INSURER F: COVERAGES CERTIFICATE 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 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. IN$R LTR TYPE OF INSURANCE ADDL SUBS W POLICY NUMBER POLICY EFF MMIDDIVVYY POLICY EXP MMIDDIYYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X Ded BI/PD $100000 35816898 11/30/12 11130113 - EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 10,00 PERSONAL BADV INJURY $ 1,000,00 X Employee Benefits GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER POlPRO- LOC JECT PRODUCTS - COMPIOP AGO $ 1,000,00 Emp Ben $ 1,000,00 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS X Phy Damage Ded $2,500 73521989 11/30/12 11/30/13 COMBINED SINGLE LIMIT Ea accident)$ 1,000,00 BODI LY INJ U RY(Per person) $ BODILY INJURY (Per accident) $ PROPERIZDAMAGE Per accitlent $ Auto Liab Ded $ 5,00 A X UMBRELLA LIAB EXCESS ICLAIMS-MADE X OCCUR 79860791 11130112 11/30113 EACH OCCURRENCE $ 6,000,00 AGGREGATE $ 6,000,00 DED I X I RETENTION None I $ A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITV ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED' FN—] (Mandatory in NH) If yes tlescribe under DE SC RIPTION OF OPERATIONS below N I A 71736418 11/30/12 11/30/13 X WC STATU- OTH- T RY LIMIT ER E.L. EACH ACCIDENT $ 1,000,00 EL DISEASE - EA EMPLOYEE $ 1,00Q00 EL UISEA$E- POLICY LIMIT _ $ �••'!DD,DD DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: Site #590 - Trans Fort/Ft. Collins - 117 N. Mason, Fort Collins, CO 80524 Trans Fol 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, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE '� zzb 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD