HomeMy WebLinkAbout507424 CUSTOM SOLAR LLC - INSURANCE CERTIFICATE (4)CUSTS-2 OP ID: DR
. O CERTIFICATE OF LIABILITY INSURANCE
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DATE 1125//2 Y01
11 /255
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
CRS Insurance Brokerage
Commercial Risk Solutions DBA
6600 E. Hampden Ave.
Denver, CO 80224
CONTACT
NAME,Demetra Rame
PHONE FAX
An No E:t:303-996-7859 IAIC NO 303-757-7719
=LESS; dramey@crsdenver.com
INSURERS AFFORDING COVERAGE
NAIC If
Jeffrey Berven
INSURER A: Westfield Insurance
24112
INSURED Custom Solar LLC
2840 Wilderness Place, Ste F
Boulder, CO 80301
INSURERB: Pinnacol Assurance
41190
INSURER C:
INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NI IMRFR• orvicinld kit Ilutzco.
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
rypE OF INSURANCE
ADDL
SUB
POLICY NUMBER
POLICY EFF
MM/DD/YYYYl
POLICY EXP
(MMIDD/YYYYJ
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FRIOCCUR
X
CWP0126513
11/10/2015
11/10/2016
EACH OCCURRENCE
$ 1,000,00
—DAMAGE (Ea occurrence)
$ 500,00
MED EXP (Any one person)
$ 5,00
PERSONAL&ADV INJURY
$ 1,000,00
GENT
AGGREGATE LIMIT APPLIES PER:
POLICY I JECT LOC
GENERAL AGGREGATE
$ 2,000,00
PRODUCTS - COMP/OP AGG
$ 2,000,00
$
OTHER:
A
AUTOMOBILE
LIABILITY
ANY AUTO
X
CWP0126513
11/10/2015
11/10/2016
COMBINED SINGLE LIMIT
Ea accident)$
1,000,00
X
BODILY INJURY (Per person)
$
ALL OWNED SCHEDULED
AUTOS AUTOS
Per accident)
BODILY INJURY ( )
$
HIREDAUTOS X NON -OWNED
AUTOS
X
PROPERTY DAMAGE
Per accident
$
X
UMBRELLA LIAR
X
OCCUR
EACH OCCURRENCE
$ 1,000,00
AGGREGATE
$ 1,000,00
A
EXCESS LIAR
CLAIMS -MADE
CWP0126513
11/10/2015
11/10/2016
DED I X I RETENTION$ 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE YIN
OFFICER/MEMBER EXCLUDED? FTI
N/A
4160305
12/01/2015
12/01/2016
I PER OTH-
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,00
E.L. DISEASE - EA EMPLOYEE
$ 1,000,00
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
-
$ 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
City of Fort Collins, its officers, agents and emplo ees are included as
additional insured for the General
ongoing operations on 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, conditions and exclusions apply.
CITYOFF
City of Fort Collins
Purchasing & Risk Management
PO Box 580
Fort Collins, CO 80522
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 R/Ej'PPRRREES�E�N�TA71VE
v IUUU-2014 ACORD CORPORATION. All rights reserved.
ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD