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HomeMy WebLinkAbout520763 AMBIENT ENERGY INC - INSURANCE CERTIFICATE (2)Client#: 1082362 AMBIEENE ACORD„- CERTIFICATE OF LIABILITY INSURANCE rDATE(MM/DD/YYYY) 4/05/2019 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER (CONTACT NAME: USI Insurance Services, LLC PHONE A 800 873-8500 C, No, Ext. _ : (A/C No): P.O. Box 7050 E-MAIL AB Englewood, CO 80155 ADDRESS: - - --- - - INSURER(S) AFFORDING COVERAGE NAIC # 800 873-8500 -- INSURER A : Hanford Casualty Insurance Company 29424 INSURED Ambient Energy, Inc. INSURER B : Hanford Accident & Indemnity Company 22357 ------ INSURER C : Liberty Inaurance Underwriters, Inc. 1449 7th Street, Suite 440 19917 INSURERD: Denver, CO 80204-8898 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION MINI ER 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 ADDL!SUBR _ TYPE OF INSURANCE INSR W_ VD POLICY NUMBER _ POLICY EFF MM/DD/YYY POLICY EXP MM/DD/YYY LIMBS A �( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 34SBWPG4483 4/01/2019 04/01/202 EACH OCCURRENCE $2 000 ON pAMA�E TO RENTED PREMISES Eaoccurrence $1 000 000 MED EXP (Any one person) $1 O 000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �I ECT [I LOC GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 _OTHER: $ A AUTOMOBILE LIABILITY 34SBWPG4483 4/01/2019 04/01/202 Ea BIKED SINGLE LIMIT 2,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNED AUTOS ONLY X O -O ONLY X BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLALIAB X OCCUR 34SBWPG4483 4/01/2019 04/01/202C EACH OCCURRENCE $1 000000 AGGREGATE $1 000 000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $10000 $ B AND EMPSCOMPENSATIONYERS'LI(LIT AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? � (Mandatory in Nn)E.L. ' It es, describe under DESCRIPTION OF OPERATIONS below -- ---- C ,Professional Liability Claims Made N/A 34WEGVY3870 4/01/2019 04/01/202 X PER OTH- ER E.L. EACH ACCIDENT O $100 OOO DISEASE - EA EMPLOYEE $1 00O 000 E.L. DISEASE - POLICY LIMIT $1 000 000 AEXNYABGEBY002 /01/2019 04/01/2020 , $2,000,000 per claim $2,000,000 annl aggr. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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; and Additional Insureds under Umbrella/Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. (See Attached Descriptions) City of Fort Collins Attn: Brian Hegort PO BOX 580 Fort Collins„ CO 80522-0000 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 (2016/03) 1 of 2 #S25412341/M25411663 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P1 DZP