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HomeMy WebLinkAbout507242 CUSTOM SOLAR LLC - INSURANCE CERTIFICATE (7)DDIYYYY) M (MI DATE ��. CERTIFICATE OF LIABILITY INSURANCE 111612017 DATE(M/ 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 . PRODUCER CONTACT NAME; Cally Lever Commercial Risk Solutions PHONE 303-996-7858 ----TF,,Axc. 303-757-7719 6600 E Hampden Ave Ste 200 EAI , No, Extl Denver CO 80224 ADDRESS: clever@crsdenver.com INSURED Custom Solar LLC 2840 Wilderness Place, Ste F Boulder CO 80301 CLISTS-2 A;Westfield Insurance B:Pinnacol Assurance INSURER D : INSURER E : nnVFDAr:FS r_FDTIFIrATF IUI IMRFD. 576492012 D11:1/1¢I(VU IUI IrU1RFD• NAIC 4112 1190 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. IN5R LTR TYPE OF INSURANCE IN D WV POLICY NUMBER POLICY EFF MM/DDIYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ' I X OCCUR L_ _ _ Y CWP0126513 11/10/2017 11/10/2018 EACH OCCURRENCE $1,000,000 WA�ETO-RENTE6 PREMISES fEa,pqcurreqqeJ $500,000 MED EXP (Anyone person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY ] JE a LOC OTHER: GENERALAGGREGATE $2,000,000 PRODUCTS - COMPIOP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY Y CWPO126513 11/10/2017 11/10/2018 Ea accident) $1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ OPERTY DAMAGE Per accident sic $ — — -- E A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CWPO126513 11/10/2017 11/10/2018 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DIED I X . RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? Y I (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 4160305 12/1/2017 12/1/2018 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E-L. DISEASE- POLICY LIMIT $1,000,000 i DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins, its officers, agents and employees are included as additional insured for ongoing operations on the General Liability and included as additional insured on the Auto Liability with respect to operations of the named insured for the certificate holder as required by written contract. All policy terms, conditions and exclusions apply. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins Purchasing & Risk Management THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 580 ACCORDANCE WITH THE POLICY PROVISIONS. Fort Collins CO 80522 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD