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HomeMy WebLinkAbout507424 CUSTOM SOLAR LLC - INSURANCE CERTIFICATE (3)� V DATE (MM/DD.'YYYY) A 4C 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 endorsement(s). PRODUCER CONTACT NAME: Cityllyn Green Commercial Risk Solutions PNONE 303 996-7840 FAX :303-757-7719 6600 E Hampden Ave Ste 200 E-MAIL Denver CO 80224 ADDRESS: cgreenocrsdenver.com INSURER A: Westfield Insurance 24112 INSURED CUSTS•2 INSURER B : Plnnacol Assurance--- — _ 41190 Custom Solar LLC - 2840 Wilderness Place, Ste F INSURER O i Boulder CO 80301 JNSURER0: INSURER E : rr1vC0 A!_CO rCDrICl( ATC AIIIRARCD• )A77SGOS'3 RFVISIr)N NIIIIARFR- 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. ILTSR TYPE OF INSURANCE NSID - 7BA POLICY NUMBER MM D/YYYY MM/DD/YLICY YYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y CWP0126513 11/10/2018 11/10/2019 EACH OCCURRENCE $1,000,000 CLAIMS -MADE LX OCCUR PREMISES (Ea oG��rrQnyej— $ 500 —j MED EXP (Ary one persons $ 5,000 1 I PERSONAL 8 ADV INJURY $1.000,000 AGGREGATE LIMIT APPLIES PER: $ 2 000,000 GENT GENERAL AGGREGATE ---- — I PRO- POLICY _� JECT LOC PRODUCTS COMPIOP AGG $ 2 000,000 $ OTHER: A AUTOMOBILE LIABILITY CWP0126513 11/10/2018 11/10/2019 COMBINED SINGLE LIMIT (E a e..wA�t) $1,000,000 — — $ X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS — X HIRED X NON -OWNED PROPERTY DAMAC3E $ AUTOS ONLY AUTOS ONLY L(t'9CSJ�sitltl.... ....... ..._..__.-.�. $ A X UMBRELLALIAS X ! OCCUR CWP0126513 11/10/2018 11/10/2019 EACH OCCURRENCE $1,000,000 EXCESS LIAR i CLAIMS -MADE AGGREGATE $1,000,000 � {�__ X DED RETENTION $ n$ 6 WORKERS COMPENSATION 4160305 12/1/2018 12/1/2019 'X IPER SEAT �R AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000 ANYPROPRIETORMARTNER/EXECUTIVE OFFICERMEMBEREXCLUDED? 7y N/AI ---------_ E.L DISEASE_ •_ EA_EMPLOYEE'_ (Mandatory in NH) j I $1,000.000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,000.000 I I DESCRIPTION OF OPERATIONS; LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Certificate Holder is included as additional insured on the General Liability with respect to ongoing operations of the named insured for the certificate holder as required by written contract. All policy terms, conditions and exclusions apply. CERTIFICATE HO City of Fort Collins 215 North Mason Street 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 © 1988-2015 ACORD CORPORATION. All rignts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2 of 2 1443