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Home My WebLink AboutTESLA INC - INSURANCE CERTIFICATE' 7 ® DATE (MM/DDIYYYY) A�C'OR" CERTIFICATE OF LIABILITY INSURANCE 10/26/2018 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 have ADDITIONAL INSURED provisions or 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 CONTACT MARSH RISK & INSURANCE SERVICES NAME___..--_ PHONE FAX A! _ - 345 CALIFORNIA STREET, SUITE 1300 1 � No. Ex1_(A/C, Nol: CALIFORNIA LICENSE NO. 0437153 E-MAIL SAN FRANCISCO, CA 94104 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # CN104275261-TESLA-GAWUL-18- _ _ INSURER A : N/A N/A INSURED INSURER B : Zurich American Insurance Company 16535 Tesla, Inc. 6800 Dumbarton Circle INSURER C : NIA N/A Fremont, CA 94555 INSURER D I INSURER F : I I rrw�oerco f`CRTICI!`ATC 1U11MRFR• RFA-nn353n747-n3 RFVIRION NIIMRFR- 1 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 SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY GLO1074588-01 10/31/2018 10/31/2019 EACH OCCURRENCE $ 2,500,000 Fv� CLAIMS -MADE OCCUR Includes Host Liquor Liability DAMAGE TO TED PREMISES (Ea occurrence) $ 2,500,000 X SIR $750,000 MED EXP (Any one person) $ 5,000 X Tort Contrac Liab, No XCU Excl PERSONAL & ADV INJURY $ 2,500,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 20,000,000 PRODUCTS - COMP/OP AGG $ 6,000,000 X POLICY ❑ PRO ❑ LOC JECT $ X OTHER: 6M per Pro ect/Loc A AUTOMOBILE LIABILITY MBINED SLIMIT EaCOaccident $INGLE , BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Participant and Installer Certification for system size is between 10kW or more. City of Fort Collins Utilities is included as Additional Insured on the General Liability policy as required by written contract, but only with respect to liability arising out of the Named Insured's operations. c City of Fort Collins Utilities 117 N MasonStreet 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 of Marsh Risk & Insurance Services Stephanie Guaiumi jttta.�.i CO ttw^ti' V IUtft$-ZUTb At,UKU t,.UKMUKA I tUro, All rtgnls reserveu. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD