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HomeMy WebLinkAboutMASUN ENERGY SYSTEMS INC - INSURANCE CERTIFICATE (6)A� o CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 6/28/2018 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 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: ME: Flood and Peterson PNONN (970)266-7118 FAC No: (970)506-611146 Corporate Mailing Address: A SS: BDanielsonlFloodPaterson.con P.O. Box 578 INSURIMP AFFORDING COVERAGE NAIC 0 Greeley CO 80632 INSURERA:Cincinnati Specialty Underwriters 13.3037 INSURED INSURERB:Travelers Indemnity Company of CT 25682 MaSun Energy Systems, Inc. tNSURERC:Pinnacol Assurance 41190 308 S. Summit View Drive INSURER D: INSURER E : Fort Collins CO 80524 INSURER F: rnVFRArFR CERTIFICATE NIIMRFR•CLI862824121 REVISION Nt1MRFR- 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. ILT R TYPE OF INSURANCE N DL Vivo31R POLICY NUMBER MOLK:Y EFF PNUUUtYY P LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 11000,000 A CLAIMS -MADE III OCCUR PREMISES ox $ 100.000 _ X MED EXP (Any one person) $ 2,000 $5,000 Deductible - CSU0060939 �07/30/2017 07/30/2018 FD / B1 PERSONAL & ADV INJURY $ _ 11000, 000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 E PRO - POLICY E1JEcT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY LI COMBINED SINGLE MIT Ea accident) $ 11000,000 BODILY INJURY (Per person) B Z ANY AUTO ALL OS SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS BA-75791497A-18-SEL 06/30/2018 06/30/2019 $ $ _ _- $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident UnlnsuredMotorist -BI Is 11000,000 UELLA LIM MBR OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAR CLAIMS -MADE $ DED RETENTION $ WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE- C (Mandatory In ER EXCLUDED? (Mandatory In NH) NIA 4009414 07/01/2019 07/01/2019 OTH- Z STAT TE ER $ 11000,000 E.L. EACH ACCIDENT E.L DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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. City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 1,A14%,CLLA I IV19 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 REPRESENTATVE B Danielson, CISR/BDA -/3'C44"j ` ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)