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HomeMy WebLinkAboutMASUN ENERGY SYSTEMS INC - INSURANCE CERTIFICATE (4)DATE (MM/DD/YYYY) A� V CERTIFICATE OF LIABILITY INSURANCE s/2/2017 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 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 NAME: Brianne Danielson, CISR Flood and Peterson n/c°NNo Xt: (970) 266-7118 VAX No): (970)506-6846 Corporate Mailing Address: AIL ADDRESS:BDanielson@FloodPeterson.com P.O. Box 578 INSURERS AFFORDING COVERAGE NAIC # Greeley CO 80632 INSURERA:Cincinnati Specialty Underwriters 13037 INSURED INSURERB:Travelers Indemnity Company of CT 25682 MaSun Energy Systems, Inc. INSURERc:Pinnacol Assurance 41190 308 S. Summit View Drive INSURERD: INSURER E : Fort Collins CO 80524 INSURERF: rr1VFRArFC CFRTIFICATF NIIMRFR-CL178218967 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. INSRPOLICY LTR TYPE OF INSURANCE INgn wvn SUER POLICY NUMBER EFF POLICY EXP MM/DD/YYYY MM/DD/YYYV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE Fx_1 OCCUR DAMAGE RENTED PREMSESOEaoccurrence $ 100,000 MED EXP (Any one person) $ 2,000 X $5,000 Deductible - CSU0060939 07/30/2017 07/30/2018 _ PD / BI PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: %� POLICY PRO LOC JECT PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 11-1579w97A-17-SEL 06/30/2017 06/30/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON OWNED HIRED AUTOS AUTOS Uninsured Motorist- BI $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAR iCLAIMS-MADE $ DEDRETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ C in NH) N/A 4009414 07 /O1/2017 07/O1/2018 E.L. DISEASE - EA EMPLOYE $ 1, 000, 000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 ((Mandatory If yes, describe under DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS / LOCATIONS / 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. CERTIFICATE HOLDER City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 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 B Danielson, CISR/BDA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) e/2/2017 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 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 NAME: Brianne Danielson, CISR Flood and Peterson PHONN xt: (970) 266-7118 Na: (970)506-6846 Corporate Mailing Address: E-MAILADDREss:BDanielson@F1oodPeterson.com P.O. BOX 578 INSURERS AFFORDING COVERAGE NAIC # Greeley CO 80632 INSURERA:Cincinnati Specialty Underwriters 13037 INSURED INSURERB:Travelers IndemnityCom an of CT 25682 MaSun Energy Systems, Inc. INSURERC:Pinnacol Assurance 41190 308 S. Summit View Drive INSURERD: Fort Collins CO 80524 1 INSURERF: rnvconnce f`G9ZTIGIf1ATF N1111ARPM-CL178218967 RFVISInN NIIMRFR- 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. I�TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER EFF PBVDD/YYYY MCY OLDDY EXP LIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X _ OCCUR CSU0060939 07/30/2017 07/30/2018 EACH OCCURRENCE $ 1,000,000 DAMAGETO ccurrence)$ -PREMISES Ea occurrence) 100,000 MED EXP (Any one person) $ 2,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - X POLICY I^ PRO- JECT 7J LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY B X ANY AUTO ALLOWNED _ AUAUTOS OSCHEDULED NON -OWNED HIRED AUTOS AUTOS BA-7579W97A-17-SEL 06/30/2017 06/30/2018 MBINE IN LE LIMIT$ Ea accident 1,000,000 BODILY INJURY (Per person) $ $ BODILY INJURY (Per accident) PROPERTYDAMAGE $ -. $ 1,000,000 Uninsured Motorist - El UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY �ANYPROPRIETOR/PARTNER/EXECUTIVE Y'N OFFICER/MEMBER EXCLUDED? C ((Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NSA 4009414 07/O1/2017 07/O1/2018 X PER H- STATUTE ER E.L. EACH ACCIDENT $ 11000,000 EL DISEASE- EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / 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. CERTIFICATE HOLDER GANC:tLLA 1 IUN City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 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 Danielson, CISR/BDA 1988-2014 AGORD GORPORA I ION. All ngnts reserves. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)