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HomeMy WebLinkAbout303367 CLEAN ENERGY - INSURANCE CERTIFICATE (7)CLEAENE-05 KDOHM ,acosza► CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/28/2018 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 License # 0757776 CONTACT Kimberly Shippey Newport Beach, CA - HUB International Insurance Services Inc. PHONE FAX 4695 MacArthur Court, Suite 600 (A/C, No, Ext): (A/C, No): Newport Beach, CA 92660 n oREs : kimberly.shippey@hubinternational.com INSURED Clean Energy, A CA Corp. 4675 MacArthur Court, Suite 800 Newport Beach, CA 92660 INSURER F : Federal Insurance Com Pacific Indemnitv Comil 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPINSD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR �( �( 35810-68-98 11130/2018 11/30l2019 EACH OCCURRENCE $ 1,000,000 DARM occu RED AGEEMSETO(Ea $ 1,000,000 MED EXP (Any oneperson) _ $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY a jp&- 7 LOC GENERAL AGGREGATE $ 2,000,600 PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER A AUTOMOBILE LIABILITY COMBciND d.n SINGLE LIMIT $ 1,000,000 BODILY INJURY Per erson $ ANY AUTO X X 7352-19-89 11/30/2018 11/30/2019 OWNED SCHEDULED A�U�T�O�S ONLY AUTOSSWNE Ix BODILY INJURY Per accident $ PPeOr aCcltlentDAMAGE $ AUTOS ONLY X AUOTOS ONL� A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 AGGREGATE $ 6,000,600 EXCESS LIAB CLAIMS -MADE 7986-07-91 11/30/2018 11/30/2019 DIED RETENTION $ $ B WORKERS COMPENSATION LIABILITY AND EMPLOYERS' YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A X 187173-64-18 11/30/2018 11 /30/2019 X PTT TE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Prof. Liability/E&O _T MKLV7PL0003435 11/30/2018 11/30/2019 Each Claim/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Site #590-Trans Fort/Ft. Collins - 117 N. Mason, Fort Collins, CO 80524. Trans Fort Ft Collins City's Director of Purchasing & Risk Management, its elected and appointed boards, commissions, officers, agents, employees and volunteers are included as additional insured as respects general liability and auto liability, as required by written contract, and is primary and non-contributory, subject to the the terms and conditions of the policy and attached forms. Seperation of Insured applies. Waiver of subrogation applies as respects general liability, auto liability and workers compensation per the attached forms. Excess Liability is follwing form. 30 day notice of cancellation, except 10 days for non-payment. Trans Fort Ft Collins City's Director of Purchasing & Risk Management 215 N. Mason 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 ifk".-" ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD