HomeMy WebLinkAbout303367 CLEAN ENERGY - INSURANCE CERTIFICATE (8)ACOR? CERTIFICATE OF LIABILITY INSURANCE
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DATE (MM DD YYYV)
1 11 /24/2015
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 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
Dodge Insurance Services, Inc.
DBA: Arroyo Insurance Services
3510 Torrance Blvd Suite 305
coxrNAME:ncr Rosemary Gomez
PHONE N Fall.310-356-8218 FAXUUQ 310-316-1825
EAIL
-M. rosemaryg@arroyoins.com
INSURERS AFFORDING COVERAGE
NAIC #
Torrance CA 90503
INSURER A: Federal Insurance Co
20281
INSURED CLEAN-1
B:PaciflcIndemnity Co.
20346
Clean Energy, A CA Corp.
-INSURER
INSURER c :Ace Property & Casualty
20699
4675 MacArthur Court, Ste #800
Newport Beach CA 92660
INSURER D:
INSURER E :
INSURER F :
C(1VFRA(21zA CFRTlPICATF KII IMRFR• 693838464 RPVISIr1N1 WIIMRPR-
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
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DDfYYYY
POLICY EXP
MMIDDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
35816898
11/30/2015
11/30/2016
EACH OCCURRENCE
$1,000,000
CLAIMS -MADE �X OCCUR
DAMAGE TO R
PREMISES( aENcwTEDnceI
$1,000,000
X
MED EXP (Any one person)
$10,000
Ded BI/PD $100k
PERSONAL B ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$2,000,000
POLICY E jRo- F—xl LOC
PRODUCTS - COMP/OP AGG
$2,000,000
$
OTHER:
A
AUTOMOBILE LIABILITY
73521989
11/30/2015
11/30/2016
Ea accident
$1,000,000
BODILY INJURY(Per person)
$
ANY.AUTO
AUTOS�EDAUTOSULED
BODILY INJURY (Peraccident)
$
HIRED AUTOS X NON -OWNED
AUTOS
Ix
PROPERTY DAMAGE
Per accident
$
Auto Liability Ded
$5,000
A
X
UMBRELLA LIAB
X
OCCUR
79860791
11/30/2015
11/30/2016
EACH OCCURRENCE
$6,000,000 "
AGGREGATE
$6,000,000
EXCESS LIAR
CLAIMSMADE
DED X RETENTION $None
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
OANY
FFICEOPRIETOER EXCLUDED? ECUTIVE I
NIA
71736418
11/30/2015
11/30/2016
XOTH-
STATUTE ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEd
$1,000,000
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
I E.L. DISEASE - POLICY LIMIT
1 $1,000,000
C
Excess Liability
G27923501 001
11/30/2015
11/30/2016
Each Occurrence 8,000,000
Retention $10,000
Aggregate 8,000.000
DESCRIPTION OF OPERATIONS I 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
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Trans Fort Ft Collins City's Director of Purchasing & ACCORDANCE WITH THE POLICY PROVISIONS.
Risk Management
215 N. Mason AUTHORIZED REPRESENTATIVE
Fort Collins CO 80524 � n %
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ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD