HomeMy WebLinkAbout507242 CUSTOM SOLAR LLC - INSURANCE CERTIFICATE (4)AcoRo® CERTIFICATE �DF
LIABILITY INSURANCE
DATE (MM/DD"Ym
10/18/2019
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 pollcy(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 holds
In lieu;of,such endorsements ., .. _.... __......_ . _ .,..
PRODUCER
Commercial Risk Solutions
6600 E Hampden Ave Ste 200
Denver CO 80224
NAME; SanClra.TDVar
PHONE FAX
• 303-996-7801 A/c No 303-757-7719
_ _...
AD RESS: stovar crsdenver.conl
INSURE S AFFORDING COVERAGE
NAIL•
INSURER A: Westfield Insurance
24112
... CUSTS•2
INSUHED � _
.. .. .. -
INSURER B : PlnnaCOl ASSUrerl$e .
41190
Custom Solar LLC
2840 Wilderness Place; Ste F
INSURERC:
Boulder CO 80301
INSURERD:
.INSURER E:
INSURER F.:..
.
. -i
COVERAGES CERTIFICATE NUMBER ii1229d6702d 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 SHO N MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
'LTR
.: ._ ..._ ..
TYPE OF INSURANCE
A l
N
R
WVD
... _:_.. -_
POLICYNUMBER
POLtcY-EFF
.MWDWYYYY.
POLICY EXP:.�..
MMIDDIYY
.
LIMITS.
A
TMERCIAL GENERALLIABILITY
CLAIMS -MADE F-KI OCCUR
Y
CWPOI26513
I
11/1012019
111102020
EACHOCCURRENCE
$1.000.000
PREMISES Ea occurrence
$500,000
MED EXP (Any.one person)
$5,000
PERSONAL & ADV, INJURY
$1.000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X -POLICY [K] jEaT 7 LOC
OTHER:
-GENERAL AGGREGATE
$2,000,000
PRODUCTS-COMPIOP:AGG
$2000.000
is
A
-AUTOMOe1LELU191LnYY
ANY AUTO
OWNED F I SCHEDULED
AUTOS ONLY .AUTOS. .
HIRED X, NON -OWNED
AUTOS ONLY AUTOS ONLY
I
CWP0126513
- - ---
11117012D7911l10/2020
`
-
COMBINED SINGLE LIMIT -
Eaacadent
--
$.1;000.000
X
BODILY INJURY (Per person)
S
9001LV INJURY (Per accident)$
X
PROPERTY DAMAGE
- Per accidem
$.
_
S
A
X
UMBRELIALIAB
EXCESS LIAB
X OcCUR
CLNMS•MADE
I
_CWP0126513I
11/1012019
.
1111012020
EACH OCCURRENCE
$1,000,000
.AGGREGATE
$1,000,000
DEO I X I RETENTION $-
g
-
WORKERS COMPENSATIONER
AND. EMPLOYERS'.LIABILrrY
ANYPROPRIETOR/PARTNERIEXECUTIVE Y'.
OFFICER1dEMBEREXCLUDED?
(Mandatory" 1n NH)-
It yyes, describe. under
DESCRIPTION OF OPERATIONS.bebw .-_ -.
NIA
-.
-
i - .
4160365. -
- . .. -
12/1/2019
12/l2020
- -
X STATUTE ,ER
. E.L. EACH ACCIDENT
$1,000,000
EL. DISEASE: EA EMPLOYEE
'
$1;000,000 .
E.L. DISEASE- POLICY LIMIT
$ 1;000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space IS required)
City of Fart Collins, its officers, agents and employees are included'es 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,
conditionsand exclusions apply.
CERTIFICATE HOLDER I CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE .THEREOF, NOTICE WILL. BE .DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins Purchasing & Risk Managerr
ent
PO Box 5580 -
-
Fort Collins CO 80522
AUTHORIZED REPRESENTATIVE
0 19882015 ACORD CORPORATION. All rightsreserved.
ACORD 25 (2016/03) The ACORD name nd logo are registered marks of ACORD
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