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Home My WebLink About303367 CLEAN ENERGY - INSURANCE CERTIFICATE (10)ACOR�� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 11 /23/2016 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 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 rights to the certificate holder in lieu of such endorsements . CONTACT PRODUCER NAME, Rosemary Gomez -A _ Dodge Insurance Services, Inc. PHONE 310-356-8218 Fe N ,. 310-316-1825 DBA Arroyo Insurance Services `"�' 3510 Torrance Blvd Suite 305 Torrance CA 90503 INSURED Clean Energy, A CA Corp. 4675 MacArthur Court, Ste #800 Newport Beach CA 92660 AnnR� . rosemaryg(garroyolns.com INSURERS AFFORDING COVERAGE INSURER A: Federal Insurance CO CLEAN-1 INSURER B: Pacific Indemnity Co. INSURER c :Ace ProDerty 8r Casualtv INSURER E : 1'nX1I=DA2C'C rCOTICIr'ATF NI IMRI=D• 14.'179664A1 RFVICInN NI IMRFR• NAIC # 51 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 DCSUBR INSD WVD POLICY NUMBER POLICY EFF POLICY EXP MMJDD/YYYY MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY 35816898 11/30/2016 11/30/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE ❑X OCCUR DAMAGE TO I PREMISESEaoccu ence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY a ECT a LOC PRODUCTS - COMP/OP AGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY 73521989 11/30/2016 11/30/2017 OMBINED Ea accident SINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ X ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY $ A X UMBRELLA LIAB X OCCUR 79860791 11/30/2016 11/30/2017 EACH OCCURRENCE $6,000,000 AGGREGATE $6,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERiEXECUTIVE Y 71736418 11/30/2016 11/30/2017 X STATUTE ERH E.L. EACH ACCIDENT $1,000,000 D? OFFICER/MEMBER EXCLUDE (Mandatory in NH) N / A E.L. DISEASE - EA EMPLOYE $1,000,000 _ E.L. DISEASE -POLICY LIMIT If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 C Excess Liability G27923501002 11/30/2016 11/30/2017 i Each Occurrence 8,000,000 Aggregate 8,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Site #590-Trans Fort/Ft. Collins - 117 N. Mason, Fort Collins, CO 80524. Endorsements apply if required by written contract. r`CDTICIr ATc uni 111=0 rANrFI I ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Trans Fort Ft Collins City's Director of Purchasing & THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management ACCORDANCE WITH THE POLICY PROVISIONS. 215 N. Mason Fort Collins CO 80524 AUTHORIZED REPRESENTATIVE I V_r av U 1988-2015 ACORD CORPORA I ION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD NOTICE TO OTHERS ENDORSEMENT — SCHEDULE NOTICE BY INSURED'S REPRESENTATIVE Named Insured Endorsement Number Clean Energy, A CA Corp 023 Policy Symbol Policy Number Policy Perlod FSfecdva Date of Endorsement XOO G27923601 002 11/30/2016 to 11/30/2017 1113012016 Issued By (Nano of Insurance Company) ACE Property and Casualty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel this Policy priorto Its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the "Schedule") by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named insured, and any other party whom we are required to notify by statute and In accordance with the cancellation provisions of the Policy. B. The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organizations) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C. We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect Information that you or your representative may use. D. We will only be responsible for Bonding such notice to your representative, and your representative will In turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or In causing your representative to provide the Schedule. E. This endorsement does not apply In the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. Authorized Representative ALL-32686 (01111) Page 1 of 1