HomeMy WebLinkAbout507242 CUSTOM SOLAR LLC - INSURANCE CERTIFICATE (2)CUSTS-2 OP ID: TV
A�RD' CERTIFICATE OF LIABILITY INSURANCE
DAM /071201(MMIDDfY3Y)
11/0712013
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
CRS Insurance Brokerage
Commercial Risk Solutions DBA
6600 E. Hampden Ave.
Denver, CO 80224
Jeffrey Berven
NUq$NjEAcT Jeffrey Berven
PHONE F
UUC, o •303-996-7801 A/cNei: 303-757-7719
Ed1AIL -
ADDRESS:
INSURE S AFFORDING COVERAGE
NAIL•
INSURER A: Westfield Insurance
INSURED Custom Solar LLC
INSURER B: Pinnacol Assurance
2840 Wilderness Place, Ste F O ���
Boulder, CO 80301
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.
INSR
LTR
TYPE OF INSURANCE
ADDL
BUSH
POLICY NUMBER
MMID EFF
M POLICY
YY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FRI OCCUR
X
CWP0126513
11/10/2013
11/10/2014
EACH OCCURRENCE
$ 1,000,00
PREMISES Ee occurrence
$ 300,00
MED EXP (Any one person)
$ -- 10,00
PERSONAL B ADV INJURY
$ 1,000,00
GENERAL AGGREGATE
$ 2,000,00
GEN1 AGGREGATE LIMIT APPLIES PER:
X POLICY PR0. LOC
PRODUCTS - COMP/OP ADD
S 2,000,00
- -
S
A
AUTOMOBILE -LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOHIRED SAUTOS
AUTOS X NON -OWNED
AUTOS
Ix
X
CWPOI26513
11/10/2013
-
-
11110/2014
COMBINED SINGLE LIMIT Ea amida
n
1,000,00
_
BODILY INJURY(Per Person)
$
BODILY INJURY(Per accident)
$
PROPERTY DAMAGE
PER ACCIDENT
$
$
A
X
UMBRELLA LIAR
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
CWP0126613
11/10/2013
11/10/2014
EACH OCCURRENCE
$ 1,000,00
AGGREGATE
$ 1,000,00
DED X RETENTION 0
is
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIE%ECUTMEYIN
MPFICERIMEMBERandstory In NH)
Hyee, describe under
DESCRIPTION OF OPERATIONS below
NIA
100305
11/2012012'
1=1/2013
X WC STATU- OTH-
E.L. EACH ACCIDENT
$ 1,000,00(
E.L. DISEASE - EA EMPLOYEE
E.L.
S 1,000,00
E.L. DISEASE - POLICY LIMIT
$ 1,000,
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Adaeh ACORD 101. Addle ... I Remarks Schedule, If more space la reaulred)
City of Fort Collins, its officers, agents and employees are included as
additional insured for ongoing operations on the General Liability and
included as additional insured on the Auto Liability with respect to
operations of the named insured for the certificate holder as required by
written contract. All policy terms, conditions and exclusions apply.
CITYOFF
City of Fort Collins
Purchasing Sr Risk Management
PO Box 580
Fort Collins, CO 80522
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
rc11GRR-9n1n ACORD CORPORATION. All riahts
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD