HomeMy WebLinkAboutSOLARCITY CORPORATIONS - INSURANCE CERTIFICATErs�mx¢xwe
CERTIFICATE OF LIABILITY INSURANCE
III
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. H 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).
PRODUCER 0726293 1.-{15-5{6-9300
CONTACT NAP8readaa QLLiQuinlan
E:
Arthur J. Gallagher E Co.
PHONE - FAX--
ZINC
Insurance Brokers of California, Inc., License #0726293
INC ty ,g.{15-536-{020 NOR. _
1255 Battery Street N450
EJIp Brandan_QYialamajg.com
Sea Francisco, CA 94111
INVURNSMAFFORDINGOOVERAGE _ NNC0
MWRER A: LIBRRy 1@F I = IBB CO 23035
MSURER a: LIZERTr 330 COB! _—
42404
SolarCity Corporation
INSURER 0:
3055 Clearview Way
INSURER a:
Ben Yateo , G 9{{02
INSURER E:
_
INSURER F:
COVFRAC.rS CFRTIFICATF NUIURFR- 36397753 REVISION MUMRER-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIIE 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.
Ii n
TYPE OF INWRANCE
ADDIL
U
POLICY NUMBER
POLICY EFF
POLICY IXP
DMA
A
OEISRAL LWBIIfTY
TB2661066265053
09/01/1
09/01/14
EACHOCCURRENCE
f 1,000,000
i COMMERCIAL GENERAL LIABILITY
PREMISES$100,000
CLAIMSIADE a OCCUR
MED E%P w
f 10,000
i Deductible: $25,000
PERSpAI { AOV RDIIRY
f 1,000,000
GENERAL AGGREGATE
f 2,000,000
GENL AGGREGATE UNIT APPLES PER
PRODUCTS - COMP/JP AGO
f 2.000,000
i POLICY PRO LOC
f
A
AMTo11OBILE LAIIIJP/
AS2661066265043
COMBINED SINGLE LIMITAft 1
1, 000, 000
BODXYINJURY(Fw Paam)
f —.
i ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Par edtldand)
f
PROAUTOS (ParPERTY DAMAGE
f
HIRED AUTOS NONBIMED
It
B
i
UMBRELLA UAB
i
OCCUR
TH7661066265013
09/01/1
09/01/14
EACH OCCURRENCE
110,000,000
AGGREGATE
f 10,000,000
EXCESS LAB
CLAIMS -MADE
DED I Z I RETENTION 10, 000
B
B
WORNFRS COMPENSATION
AND EYPLOYERT LABILnY
MY PROPRIETORPARTNERERECUTIVE YIN
OFFICERa1EMBEREXCLUDED9 a
NIA
M.L766DO66265023 (Ded)
NC7661066265033 (NI Re[r))
09/01/1
09/01/1
09/01/149
09/03/14
i WCSIATLL ORH
E.I. EACH ACCIDENT
f 1,000,000
E.L.DWME-EAEA OM
S1,000,000
pawHw"In NH)
Ilyyeeccd calm undw
DESCRIFRON OF OPERATIONS We
E.L. DISEASE -POLICY LIMIT
f 1,000,000
DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES Which ACORD 101, AddHlonal Ranni*z SCHadWa, N m sa Nwubadl
Additional Inaured status and Primary wording on the General Liability 1s provided as required by written contract.
City of Fort Collins is shown as an Additional Ineured(s) solely with respect to General Liability coverage as
evidenced herein as required by written contract.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
of Port Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
700 Wood Street AUTHORIZED REPRESENTATIVE /1n
Fort Collina , CO 80521 USA �f A✓(.. / /-lY/�
ACORD 25 (2010/05)
mend j can
36397753
®1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
tE4.:
AGENCY CUSTOMER 10:
LOC M:
®
ACORO ADDITIONAL REMARKS SCHEDULE Page of
AGENCY
Arthur J. Gallagher 6 Co.
Insurance Brokers of California, Inc.. License •0726293
NANEDINWNED
SolarCity Corporation
3055 Clear,r1w Nay
Ban Mateo , CA 96602
POUCYNumem
CAAAMR
WC CODE
EFFECiNE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
NC Policy # M766DO66265023 (Dad) includes Deductible: $150,000.
ACORD 101 (2008/01) C 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
v
0
n
7
z
w