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HomeMy WebLinkAbout520763 AMBIENT ENERGY INC - INSURANCE CERTIFICATE (3)Client#: 1082362 AMBIEENE ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD1YYYY) 1 4/04/2016 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 endorsement(s). PRODUCERCONTACT US[ Colorado, LLC Prof Liab P.O. Box 7050 Englewood, CO 80155 800 873-8500 NAME: H/ N o FAX A/C, No Ext : 800 873-8500 : E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Hartford Casualty Insurance Co. 19682 INSURED Ambient Energy, Inc. INSURER B : Navigators Insurance Company 42307 INSURER c :Hartford Ins Co of the Midwest 130 West 5th Ave. Denver, CO 80204 INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 LT_R TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF POLICY EXP MM/DD/YYYY) JMM/DD/YYYYL LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 34SBWPG4483 4/01/2016 04/01/2017 EEACHG�OEECCURRENCE s2,000,000 CLAIMS -MADE OCCUR D PAEMISES0(ER.E curtDence) $300 OOO IVIED EXP (Any one person) $10 000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 ECOT F LOC GENERAL AGGREGATE s4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 I OTHER: $ A AUTOMOBILE _ _ LIABILITY Y Y 34SBWPG4483 /01/2016 04/01/201 Eea�deDSINGLELIMIT 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ $ X PROPERTY DAMAGE Per accident EACH OCCURRENCE 4/01/2016 04/01/2017 $ $1 000000 A X UMBRELLA LIAB X OCCUR Y Y 34SBWPG4483 AGGREGATE $1 000 000 EXCESS LIAB CLAIMS -MADE 1 DED I X., RETENTION $1 O 000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below N / A Y 34WEGVY3870 4/01/2016 04/01/201 X PER OTH- E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1 000 000 E.L. DISEASE - POLICY LIMIT $1,000 000 B Professional CM16DPL26079 4/01/2016 04/01/2017 $2,000,000 per claim Liability $2,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under General Liability; Designated Insured under Automobile Liability; and Additional Insured under Umbrella Liability but only with respect to liability arising out of the Named Insured's work performed on behalf of the certificate holder and owner. (See Attached Descriptions) City of Fort Collins 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 REPRESENTATIVE ACORD 25 (2014/01) 1 Of 2 #S17602317/M17597847 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MXVZP DESCRIPTIONS (Continued from Page 1) The General Liability, Automobile Liability, Umbrella insurance policies applies on a primary and non contributory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella Liability and Workers Compensation. The Umbrella Liability policy provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Please note that Additional Insured status does not apply to Professional Liability or Workers' Compensation. Proprietors/Partners/Executive Officers/Members Excluded: RENEE J AZERBEGI, ELECOFC SAGITTA 25.3 (2014/01) 2 of 2 #S17602317/M17597847