HomeMy WebLinkAbout507242 CUSTOM SOLAR LLC - INSURANCE CERTIFICATE (5)AC"Rb CERTIFICATE
PF LIABILITY INSURANCE
°� `""°°"""Y'
10/18/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONA
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
NEGATIVELY
BE OWCaTHIS CERTIFICATE �MOFNSUERANCE DOES N&T
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE
OLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL'INSURED;;the
policy(es) 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 _
Commercial Risk Solutions
6600 E Hampden Ave Ste 200
Denver CO 80224
.NAME; Sandra-TOVar
PHONE.: 303 996-7801
.
ac No : 303 757-7719 .
• DRESS: stdvar@drsd6nvdr.com
INSURE AFFORDWG COVERAGE
NAICV
INSURERA: Westfield Insurance
24112
.INSURED
Custom Solar LLC
COSTS-2
INSURERS:. Plnnacol Assurance
41190
2840 Wilderness Place, Ste F
Ir1suREnG:
Boulder C0 80301
INSURER D:
INSURER E
INSURER F.:...-
COVFRAGFS CFRTIFICATE NUMBER- i197A5RRR REVISION NUMBER:
THIS, IS TO CERTIFY THAT THE POLICIES OF, INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE, FORE. THE POLICY PERIOD '
INDICATED. NOTWITHSTANDING ANY REQUIREMENT ; TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE. MAY BE ISSUEDOR 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
TYPE OFINSURANCE
14=
O
SUER
WVD
..
POLICYNUMBER
. POLICCY EFF.
MMID6IYY
( POLICCY EXP'
MkWO/YYY
LIMITS.
A
X
COMMERCIALGENERAL LIABILITY
CLAIMS -MADE OCCUR
Y
`
CWPO126513.
-
11/10/2619
1t/102020
EACHOCCURRENCE 1
$1,000,000
DAMAGE TO TED
PREMISES' Ea aarrence
$ 500,000
MED EXP (Any one person)
$5,000
PERSONAL BADVINJURY
$1.000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY 17�_71 JECT LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS :-COMP/OP.AGG-
$2,000,000
$
A
AurogiddiLELIABIIJTY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
I
X AUTOS ONLY X AUUTNOS ONLDY
Y
CVV00126513
11/102019
11/102020
_
COMBINED SINGLE LIMIT
Ea accident).____,
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY. (Per accident)
$
_(PFlerr aEU.RI THY DAMAGE
$
..
A
'X
UMBRELLAUAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
CVVP0126513
111102019
4
1.
..
11110/2020
....
EACH OCCURRENCE
..
$1;000.000
X
AGGREGATE
$1,000,000'
DED !( RETENTIONS.
_. -.. ....- _ .__.. _
S.._ .-
B
-.
WORKERSCOMPENSATION
AND EMPLOYERS'.0YIN
ANYPPOPRIETORlPARTNERIEXECUTIYE
OFFICEFPMEMSEREXCLUDED?
(Mandatory In NM
IF yes,.describe under
DESCRIPTION OF OPERATIONS bebw-
N/A
4160305
--
12/1/2019
12/iam
X STATUTE ERH
EL. EACH ACCIDENT
$1,000,000
E.L. DISEASE:. EA EMPLOYEE
$1,000;006
-
E.L. DISEASE- POLICY LIMIT
$ 1,000,000 -
I
DESCRIPnON OFOPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more apace Is required)
Certificate Holder is 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 holdiI required by written contract. All policy terms, conditions and exclusions apply.
CFRTIFICATE NntnFR I CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
THE_
City of Fort Collins
ACCORDANCE WITH THE POLICY PROVISIONS.
Purchasing Department
AUTHORIZED REPRESENTATIVE
PO BOX: 580
Fort Collins CO,80522
(9 1935-2015 ACORD CORPORATION.. All rlgnts reserved.
ACORD 25 (2016/03) The ACORD name nd logo are registered marks of ACORD
2� of 2 6225