Loading...
HomeMy WebLinkAbout520763 AMBIENT ENERGY INC - INSURANCE CERTIFICATE (7)Client#: 1082362 AMBIEENE ACOR& CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 14/04/2018 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Colorado, LLC Prof Liab P.O. Box 7050 Englewood, CO 80155 CONTACT NAME: PHONE g00 873-8500 FAX (Al. No Ext : A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 800 873-8500 INSURER A Hartford Casual insurance Company : b 29424 INSURED Ambient Energy, Inc. PO BOX 8898 INSURER B : Hartford Ins co of the Midwest 37478 ns INSURER C : Liberty Insurance Underwriters, Inc. 19917 Denver, CO 80201-8898 INSURER D : 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 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMBS A X COMMERCIAL GENERAL LIABILITY Y Y 34SBWPG4483 4/01/2018 04/01/2019 EACH OCCURRENCE $2000000 CLAIMS -MADE CI OCCUR PREMISES EaEixN.cTurrence _ $1 000,000 MED EXP (Any one person) $1 O 000 PERSONAL BADVINJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLfCY � ECT LOC PRODUCTS - COMPlOP AGG $4,000,000 $ OTHER: Ej AUTOMOBILE LIABILITY Y Y 34SBWPG4483 4/01/2018 04/01/201 COMBINED SINGLE LIMIT Ea accident$2,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB X OCCUR Y Y 34SBWPG4483 4/01/2018 04/01/2019 EACHOCCURRENCE $1 000000 AGGREGATE $1 00O 000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION $1 O 000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A Y 34WEGVY3870 4/01/2018 04/01/201 X PER T OTH- E ER E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional AEXNYABGEBY001 4/01/2017 04/01/2019 $2,000,000 per claim Liability $2,000,000 annl aggr. Claims Made DESCRIPTION OF OPERATIONS / LOCATIONS I 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 Attn: Brian Hegort PO BOX 580 Fort Collins„ CO 80522-0000 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 (2016/03) 1 of 2 #S22860707/M22674273 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BTRZP