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HomeMy WebLinkAbout506424 EXCERGY CORPORATION - INSURANCE CERTIFICATE (3)A CERTIFICATE OF LIABILITY INSURANCE 5/113/2017 THIS CERTIFICATEIS 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 endorsemen s . PRODUCER SELECTSOLUTIONS INS SRVCS LLC/PHS 101077 P: (866) 467-8730 F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME PHE WCC.."o.Ext): (866) 467-8730 (AIC.No): (888) 443-6112 ADDRESS: INSURER(S) AFFORDING COVERAGE NAICk INSURERA: Sentinel Ins Co LTD INSURED EXCERGY CORPORATION 3773 E CHERRY CREEK NORTH DR STE 575 DENVER CO 80209 INSURER B INSURER C : INSURER D: INSURER E: INSURER F: rnVFRAQFS CFRTIFICATF NI1MRFR- 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 LIN TYPE OFWS(IRANCE ADD SC7S POLICPNUMBEH POL� EFF TM POLICYEYP L&HIS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ; 2, 000, 000 CLAIMS -MADE � OCCUR PREMISES Ea occurrence) DAMAGE TO $1 , 000, 000 A General Liab 57 SBA ID2750 06/09/2017 06/09/2018 X X MEDEXP(Any oneperson) $ 0, 000 PERSONAL S ADV INJURY s2 I 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � JECT PRO- ❑X LOC GENERAL AGGREGATE ; 4 Q Q Q PRODUCTS - COMP/OP AGG s4, 000, 000 OTHER AUTOMOBILE LJABILffY COMBINED SINGLE LIMIT (Ea accident) s2 , ()00, 000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY 57 SBA ID2750 06/09/2017 06/09/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $1 , 000,000 A EXCESSLIAS CLAIMS -MADE 57 SBA ID2750 06/09/2017 06/09/2018 AGGREGATE $ , 000, 000 D X RETENTION Sl 0 r 0 0 0 r WORKERS COMPE1VSA77OA' AVDEWLOfFJWLL487LDY ANY PROPRIETOR/PARTNER/EXECUTIVEY/N PER OTH- SiAME ER E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? ❑ (Alandatoryln NH) WA E.L. DISEASE- EA EMPLOYEE If yes. describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICINMRD 101, Additional Ramarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. City of Fort Collins, its agents, officers, and employees are named as additional insured while acting under the direction of the City of Fort Collins per the Business Liability Coverage Form SS0008 attached to this policy. i+crir�r�rw� ur�� nrn rANCF1 I ATICIN 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 City of Fort Collins 700 WOOD ST FORT COLLINS, CO 80521 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD