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HomeMy WebLinkAbout520763 AMBIENT ENERGY - INSURANCE CERTIFICATEClinntdt 10R21R2 AMBIEENE ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 3/30/2015 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 endorsement(s). PRODUCER USI Colorado, LLC Prof Liab P.O. BOX 7050 Englewood, CO 80155 800 873-8500 CONTACT NAME: PHONE 800 873-8500 FAX A/C, No Ext : AIC No E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC# INSURER A: Hartford Casualty Insurance Co. 29424 INSURED INSURER B: Navigators Insurance Company 42307 Ambient Energy, Inc. 130 West 5th Ave. INSURER C : Hartford Ins. Co of the Midwest 37478 Denver, CO 80204 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 CONTRACTOR 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 ADOLSUBR I POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MWDDIYYYV LIMITS A GENERAL LIABILITY Y Y 343BWPG4483 4/01/2015 04/01/2016 EACH $2000,000 X COMMERCIAL GENERAL LIABILITY �OCCURRENCE PREMISES EaE cwEnence $300000 CLAIMS -MADE rj� OCCUR MED EXP (Any one person) $10,000 PERSONAL B ADV INJURY _ $2,000,000 GENERAL AGGREGATE s4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $4,000,000 POLICY X PECQ LOC1 1 $ A AUTOMOBILE LIABILITY X X 34SBWPG4483 4/01/2015 04/01/201 (EaCOMBINED SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ AMAGE (Per accident $ X HIRED AUTOS X AUTOS ED a UMBRELLA UAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) NIA Y 34WEGVY3870 0410112015 04/01/201 X &STATUi orH- ER E.L. EACH ACCIDENT $1 00O 000 E.L. DISEASE- EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below B Professional CM15DPL2607971V 4/01/2015 04/01/2016 $2,000,000 per claim Liability $2,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and Owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability but only with respect to liability arising out of the Named Insureds work performed on behalf of the certificate holder and owner. This insurance policies will apply on a primary, (See Attached Descriptions) City of Fort Collins 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 ACORD 25 (2010/05) 1 Of 2 #S14749629/M14650029 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LXOBC DESCRIPTIONS (Continued from Page 1) 1 noncontributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability and Workers Compensation. SAGITTA 25.3 (2010/05) 2 of 2 #S14749629/M14650029