HomeMy WebLinkAboutMOONLIGHT ELECTRIC INC - INSURANCE CERTIFICATE (4)/ 1 ®
A� o CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
7/31 /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 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
Richard Marchesini(0717310)
CONTACT
NAME:
PHONE 303-969 9287 pIC No : 303-969-8007
AIL
ADDRESS: rmarchesiniQffarmemagentcom
3900 S Wadsworth Blvd Ste 365
INSURE S AFFORDING COVERAGE
NAIC #
INSURER A : Truck Insurance Exchange
21709
Lakewood CO 80235-2220
INSURED
INSURER B : Farmers Insurance Exchange
21652
INSURER C : Mid Century Insurance Company
21687
MOONLIGHT ELECTRIC INC
INSURER D :
26731 WELD COUNTY ROAD 18
INSURER E :
1 INSURERF:
KEENESBURG CO 80643
COVERAGES CERTIFICATE NUMBER: 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
OF INSURANCE
ADDLTYPE
INSR
SUER
POLICY NUMBER
POLICY EFF
MM /DD/YYri
POLICY EXP
MMIDDIYYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
_15AMA E TO RENTED
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
CLAIMS -MADE I ^I OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
C
Y
N
604833002
06/16/2018
06/16/2019
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
X POLICY PRO LOC
AUTOMOBILE LIABILITY
A
COMBINED SINGLE LIMIT
Ea accident)
1,000,000
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
C
ALL OWNED SCHEDULED
/�
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
604833002
06/16/2018
06/16/2019
Per accident)EPROPERTY
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
A
EXCESS LIAB
HCLAIMS-MADE
604833020
06/16/2018
06/16/2019
DED X RETENTION$ IO,000
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OTH-
TINE"
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
N/A
E.I_. DISEASE - POLICY LIMIT
$
If yec, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
26731 WELD COUNTY ROAD 18, KEENESBURG, CO 80643
GEKI IFIGA It: HULUEK k,/-kNt CLLA I IVIV
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF FORT COLLINS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
21 NORTH COLLEGE ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
FORT COLLINS CO 80522
RICHARD MARCHESINI, LUTCF
ACORD 25 (2010/05) U 19BB-2010 AGUKU GUKIJUKA I IUIV. AN ngnrs reserves.
The ACORD name and logo are registered marks of ACORD