HomeMy WebLinkAboutMOONLIGHT ELECTRIC INC - INSURANCE CERTIFICATE (2)® DATE(MM/DDIYYYY)
CERTIFICATE �OF LIABILITY MbURANko
6/16/2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF *FORMATION 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 IN
SURED, NSURED, the policy(ies) must 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:
Richard Marchesini(6717310) PHON ; • 303-969-9287 FAX No); 303-969-8007
3900 S Wadsworth Blvd Ste 365 A RIESS:
Lakewood CO 80235-2220
INSURED
MOONLIGHT ELECTRIC INC
26731 WELD COUNTY ROAD 18
INSURER(S) AFFORDING
Truck Insurance Exchang
Farmers Insurance Excha
Mid Century Insurance Cc
21687
KEENESBURG CO 80643 I I INSURER F.: I I
win nrerieirn A+= ur usnrn. DPVICInL§ U1 IMRPD-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE_ LISTED
HAVE BEEN ,ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM
.BELOW
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
LTR
TYPE OF INSURANCE
ADDL
SURR
POLICY NUMBER
POLICY.EFF
MM/DD
POLICYEXP
MMIDDIYYYY
- LIMITS
GENERAL LIABILITY
EACH. OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
CLAIMS -MADE Fx] OCCUR
PERSONAL BADVINJURY
$ 1,000,000
C
Y
N
604833002
06/16/2020
06/16/2021
GENERAL AGGREGATE
8 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
X POLICY PRO- LOC
AUTOMOBILE LIABILITY
_
COMBINED SINGLE LIMIT
Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
C
ALL OWNED X
604833002
06/16/2020
06/16/2021
AUTOS AAUTOSULED
NON -OWNED
Y DAMAGE
PeO
$
HIRED AUTOS AUTOS
caPERd
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
A
EXCESSIJAB
CLAIMS -MADE
604833UJI20
06/16/2020
06/16/2021
.OED I X 1.RETENTIONS 10,000
Is
WORKERS COMPENSATION
WC STATU- OTH-
R Y LIMITS ER
- - -
AND EMPLOYERS' LIABILITY
Y❑
ANY PROPRIETOR/PARTNER/EXECUTIVE
NIA A'
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
OFFICERIMEMBER EXCLUDED?
(Maricla wy io NH)
.E.L. . DISEASE-P.OLICL'LIMIT.
1 $
If yes. describe under
DESCRIPTION OF OPERATIONS. below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, 'Additlonal
Remarks Schedule, If more space is required)
26731 WELD COUNTY ROAD 18, KEENESBURG, CO 80643
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF FORT COLLINS
THE EXPIRATION DATE THEREOF., NOTICE WILL BE DELIVERED IN
21 NORTH COLLEGE
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
FORT COLLINS CO 80522
RICHARD MARCHESINI, LUTCF
AGORD 25 (ZUIU/U5)
The ACORD n me and logo are registered nnar'Z of ACORD