Loading...
HomeMy WebLinkAboutMASUN ENERGY SYSTEMS INC - INSURANCE CERTIFICATE (7)/ A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/2/2017 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). PRODUCER Flood and Peterson Corporate Mailing Address: P.O. BOX 578 Greeley CO 80632 CONTACT Brianne Danielson, CISR NAME: A/C No Ex • (970) 266-7118 A/C No: (970)506-6846 ADDRESS:BDanielson@F1oodPeterson.com INSURERS AFFORDING COVERAGE NAIC if INSURERA:Cincinnati Specialty Underwriters 13037 INSURED MaSun Energy Systems, Inc. 308 S. Summit View Drive Fort Collins CO 80524 INSURERB:Travelers Indemnity Company of CT 25682 INSURERC:Pinnacol Assurance 41190 INSURERD: INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER:CL178218967 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 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 ADDLSUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR $5, 000 Deductible - CSU0060939 07/30/2017 07/30/2018 EACH OCCURRENCE $ 1,000,000 RETED PREM SESODAMAGE TEa oNcurrence $ 100,000 X MED EXP (Any one person) $ 2,000 PD / BI PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APTPL�IES PER: POLICY PRO- LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2, 000, 000 LMBINED $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BA-7579W97A-17-SEL 06/30/2017 06/30/2018 SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE$ e Uninsured Motorist -BI $ 11000,000 UMBRELLA LIAB EXCESS LIAB i OCCUR CLAIMS MADE EACH OCCURRENCE $ _ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/M(Mandatory in ER EXCLUDED? C (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4009414 07/01/2017 07/01/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE- EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as Additional Insured but only as respects liability arising out of ongoing operations of the named insured. CEHTIFICA I t HULUEH I,AIVVCLLA I IU11 City of Fort Collins P.O. 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) INS025 (201401) Danielson, CISR/BDA`�""nieLron.. V lUtftf-ZUl4 AUUHU GUKrUKA I IU14. All rlgnis reSerVCU. The ACORD name and logo are registered marks of ACORD 78/2/2017 E (MM/DD/YYYY) A� " CERTIFICATE OF LIABILITY INSURANCE 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). PRODUCER CONTACT Brianne Danielson, CISR NAME: Flood and Peterson A/CNN Ext: (970) 266-7118 F� No: (970)506-6846 Corporate Mailing Address: E-MAILs:BDanielson@F1oodPeterson.com P.O. BOX 578 INSURERS AFFORDING COVERAGE NAIC A Greeley CO 80632 INSURERA:Clncinnati Specialty Underwriters 13037 INSURED INSURER B MaSun Energy Systems, Inc. INSURERC:Pinnacol Assurance 41190 308 S. Summit View Drive INSURERD: INSURER E : Fort Collins CO 80524 INSURER F: CnVFRAAFc CFRTIFICATF NUMRFR-CL178218967 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 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 ADDLTYPE OF INSURANCE iNgn SUER LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY A EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE FX7 OCCUR DA AGE RENTED PRIME M SESOEa occurrence $ 100,000 MED EXP (Any one person) $ 2,000 CSU0060939 07/30/2017 07/30/2018 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 X POLICY PRO JECT LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ %{ ANY AUTO B ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS H AUTOS F-1 BA-7579w97A-17-SEL 06/30/2017 06/30/2018 BODILY INJURY (Per accident) $ PROPERTYDAMAGE accident) $ I Uninsured Motorist -BI $ 1,000,000 I UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE a( STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 4009414 07/O1/2017 07/O1/2018 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 If Yes. describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is included as Additional Insured but only as respects liability arising out of ongoing operations of the named insured. CERTIFICA I E HULUEH L.ANt r_LLA I IUIV City of Fort Collins P.O. 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 Danielson, CISR/BDA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)