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HomeMy WebLinkAbout520763 AMBIENT ENERGY - INSURANCE CERTIFICATE (3)Client#: 1082362 AMBIEENE DATE (MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 4/06/2018 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 CONTACT NAME: USI Colorado, LLC Prof Liab PHONE 800 873-8500 FAX A/C No Ext : A/C No : P.O. Box 7050 E-MAIL Englewood, CO 80155 ADDRESS: 800 873-8500 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Hartford Casualty Insurance Company 29424 INSURED Ambient Energy, Inc. 1449 7th Street, Suite 440 Denver, CO 80204 INSURER B : Hartford Ins Co of the Midwest 37478 INSURER C : Liberty Insurance Undermtters, Inc. 19917 INSURER D : INSURER E : 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDY EFF MM/DDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 34SBWPG4483 4111/2018 04/01/2019 OCCURRENCE $2 000,000 CLAIMS -MADE D OCCUR PEACH PREMISES Ea occurrence $1 000 000 MED EXP (Any one person) $10,000 PERSONAL BADVINJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY � ECT F7 LOC GENERAL AGGREGATE _ $4,000,000 PRODUCTS - COMP/OP AGG $4,000,000 $ OTHER: ,AUTOMOBILE LlABILlTY Y Y 34SBWPG4483 4/01/2018 04/01/201 COMBINED SINGLE LIMIT Ea accident 2,000,000 BODILY INJURY (Per person) $ ANY AUTO ULED AUTOS ONLY AUTOS AUTOS ONLY X NON -OWNED AUTOS ONLY X BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB X OCCUR Y Y 34SBWPG4483 4/01/2018 04/01/2019 EACH OCCURRENCE $1 000 000 AGGREGATE $1 000 000 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? � N / A Y 34WEGVY3870 /01/2018 04/01/201 X PER OTH- STATUTE E.L. EACH ACCIDENT $1 000 000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional AEXNYABGEBY001 4/0112017 04/01I201 $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 GANGtLLA 1 ILIN 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 #S22874212/M22870295 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JXDZP