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HomeMy WebLinkAbout303367 CLEAN ENGERGY ACA CORP - INSURANCE CERTIFICATECLEAN-1 OP ID: RG ,acoRO' CERTIFICATE OF LIABILITY INSURANCE DATE /13120113 11/13/2013 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 Dodge Insurance Services Inc. DBA: Arroyo Insurance Services 3510 Torrance Blvd., Suite 305 Torrance, CA 90503 CONTACT NAME: Rosemary Gomez PHONE FAX Ne EX1-310356-8218 Re: 310-316-1825 E4$aL rosema arro oins.com ADDREu: Neil S. Dodge INSURERS AFFORDING COVERAGE HAKE INSURER A: Federal Insurance Co 20281 INSURED Clean Energy. A CA Corp. 4675 MacArthur Court Suite $00 30 336"] Newport Beach, CA 92660 INSURERS: 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. ILSR TYPE OF INSURANCE ADDIL SUER POLICY NUMBER POLICY Y YPOLICY CY�P Lam A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX7 OCCUR X Ded BIiPD $100000 35816898 11/30/2013 11/30/2014 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 1,000,00 MED EXP(Any one person) $ 10,0 PERSONAL $ADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2,000,0 GEN'L AGGREGATE POLICY LIMIT APPLIES PER X PRO - PRODUCTS -COMPIOP AGO $ 2,000,0 $ A AUTOY08RE LIABILITY X ANY AUTO X ALL OWNED SCHEDULED AUTO06 X HIREDSAUTOS X NON -OWNED AUTOS 73521989 11/30/2013 11/30/2014 COMBINeED SINGLE LIMIT COMBINED acci nf 1,000,0 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE PER ACCIDEN $ Auto Liab Ded $ 5,0 A X UMBRELLA LIAR EXCESSUAB X OCCUR CLAIMS -MADE 79860791 11/30/2013 11/30/2014 EACH OCCURRENCE $ 6,000,00 AGGREGATE $ 6,000,00 DELI I X I RETENTION Non @ $ A WORK ERSCOMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVEY® OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe ur cer DESCRIPTION OF OPERATIONS below NIA 71738418 11/30I2013 11/30/2014 X WC STATU- OTH- IMTS E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE-EAEMPLOYEE S 1,000,00 E.L. DISEASE -POLICY UNIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Allach ACORD 101, AeeiNonal Remarks Schedule, If more space Is required!) RE: Site #590 - 117 N. Mason, Fort Collins, CO 80524 CTFC000 City of Fort Collins City's Director of Purchasing 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 V .r zz. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD