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HomeMy WebLinkAbout507424 CUSTOM SOLAR LLC - INSURANCE CERTIFICATE� �® DATE (MM/DD,YYYY) A C CERTIFICATE OF LIABILITY INSURANCE F11/9/2018 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 endorsements . PRODUCER CONTACT Commercial Risk Solutions NAME: __,_Caytlyn Green 6600 E Hampden Ave Ste 200 PHONE - 303 996-7840 FAX No): 303-757-7719 Denver CO 80224 ADDRESS: cgreen(o'>7crsdenver.com INSURER(SJAFFORDINOCOVERAgE I NAIC# INSURERA: Westfield Insurance 24112 INSURED CUSTS•2 INSURER B : Pinnacol Assurance 41190 Custom Solar LLC - --- 2840 Wilderness Place, Ste F INSURERC:_,_____ Boulder CO 80301 INSURER D: CAVFRAGFS CFRTIFICATF NIIMRFR•4o1S40nn7 RFVICIAN NIIIURFR. 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 - POLICY EFF POLICYEXP'_i_ LTR TYPE OF INSURANCE i POLICY NUMBER D/YYYY MM/DD/YY LIMITS A X COMMERCIAL GENERAL LIABILITY -._ CLAIMS-MADE X ,OCCUR Y CWPO126513 11/10/2018 11/10/2019 EACH OCCURRENCE I-dA-iviAG�iU FI�f�YED- --- oaurr�ngq � $ 1,000,000 ------ $ 5D0 000 PERSONAL & ADV IN_JU_RY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE __ $ 2,000,DW POLICY I X I PE LOC PRODUCTS -COMP/OP AGG $ 2.000,000 OTHER: $ A AUTOMOBILE LIABILITY Y ! CWP0126513 11/10/2018 ' 11/1012019 COMBINED SINGLE UMIT $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED �` SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) _ $ X HIRED X NON -OWNED AUTOS ONLY � AUTOS ONLY _ PROPERTVDAMAGE $ A X UMBRELLA LIAB X OCCUR CWPO126513 11/10/2018 11/10/2019 I EACH OCCURRENCE $1,000,000 EXCESS LAB I I CLAIMS -MADE AGGREGATE $ 1.000,000 $ DED 1 X RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERlEXECUTIVE a OFFICER/MEMBER EXCLUDED? N/A 4160305 12/l/2018 12M12019 X I PTA R EiL.EACHACCIDENT - $1,000,000 - $1,000,D00 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE i If yes, describe under--" DESCRIPTION OF OPERATIONS below ---" .-_.- E.L. DISEASE - POLICY LIMIT "-—---- $ 1.000.000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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. City of Fort Collins Purchasing & 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2 of 2 1440 1