HomeMy WebLinkAbout572096 GRID ALTERNATIVES - INSURANCE CERTIFICATE (2)A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY)
3/23/2017
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:
Arthur J. Gallagher & Co. PHONE 415-546-9300 EAX N . 415-536-8499
Insurance Brokers of California, Inc. LIC #0726293 Ne E.,)_
1255 Battery Street, Suite 450 E-MAIL
San Francisco CA 94111 INSURFRISI AFFORDING COVERAGE NAIC
INSURER A:Zurich American Insurance Com an 16535
INSURED GRIDALT-01 INSURER B: Crum & Forster Specialty Insurance 44520
GRID Alternatives Colorado, Inc. INSURERC: _
1120 West 12th Ave
Denver, CO 80204 INSURERD:
INSURER E :
rnvrnAf_cc rroTlCl/ ATr nuIRMOcD. 1?nr,117QR1 DcvlclnlU NIIMRFD-
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.
ADDLTSUBR INSR TYPE OF INSURANCE POLICY EF�POLICY EXP LIMITS
LTIR IN WV POLICY NUMBER MMIDDNYYY MWDDNYYY
B
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X❑ OCCUR
$10,000 Ded.
EPK116183
4/1/2017
4/1/2018
EACH OCCURRENCE
$1,000,000
PREMISEGE S ( a occurrence
$500,000
X
MED EXP (AnXone person)
$10,000
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
%( POLICY � PRO- L_l LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$2,000,000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED _— NON -OWNED
AUTOS ONLY AUTOS ONLY
BAP673781804
4/1/2017
4/1/2018
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
Per accident
$
$
UMBRELLA LIAB
EXCESS LIAB
_
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
WC574677104
4/1/2017
4/112018
X PER STATUTE ERH
E.L. EACH ACCIDENT
$1,000,000
$1,000,000
E.L. DISEASE - EA (EMPLOYE
E.L. DISEASE - POLICY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Fort Collins Utilities is added as additional insured with respect to the general liability per written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Fort Collins Utilities THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
222 Laport Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
Fort Collins CO 80521
AUTHORIZED REPRESENTATIVE
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ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD