HomeMy WebLinkAboutMASUN ENERGY SYSTEMS INC - INSURANCE CERTIFICATE (5)AGOo0®
A.. CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD(YYYY)
07/27/2018
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 endorsement(s).
PRODUCER
CONTAEr NAME: Bnanne Danielson, CISR
PHONE (970) 266-7118 970) 506-6846
A/C No Ext : A/C, No
Flood and Peterson
E-MAIL s: BDanielson@FloodPeterson.com
ADDRE
Corporate Mailing Address:
INSURER(S) AFFORDING COVERAGE
NAIC M
P.O. Box 578
INSURER A: Cincinnati Specialty Underwriters
13037
Greeley CO 80632
INSURED
INSURER B : Travelers Indemnity Company of Connecticut
25682
INSURERC: Pinnacol Assurance
41190
MaSun Energy Systems, Inc.
INSURER D:
308 S. Summit View Drive
INSURER E :
INSURER F :
Fort Collins CO 80524
enVr0AP__FQ CFRTIFICATF NIIMRFR- CL1872724562 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 LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MMJDD/YYY
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
$5,000 Deductible - PD / BI
CS00060939
07/30/2018
07/30/2019
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrenceI
$ 100,000
X
MED EXP (Any oneperson)
$ 2,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY ❑ PRC7 LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
B
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
BA7579W97A18SEL
06/30/2018
06/30/2019
(CEO,SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
Uninsured Mtorist - BI
s 1,000,000
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED.
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
4009414
07/01/2018
07/01/2019
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
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it 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.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 580
AUTHORED REPRESENTATIVE
Fort Collins CO 80522 ' 13WAk anlg&OA,.
(O 1988-2U15 ACUHU UUKFUHA I IUN. AU rlgnis reserves.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD