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HomeMy WebLinkAbout506424 EXERGY CORPORATION - INSURANCE CERTIFICATEHISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Certificate of Commercial General Liability Insurance This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Named Insured: Excergy Corporation Insurer Name: Hiscox Insurance Company Inc. Policy Number: UDC-1263958-CGL-14 Type of Coverage: Occurrence Policy Effective Date: March 14, 2014 Policy Expiration Date: March 14, 2015 Limits of Insurance Each Occurrence: $ 1,000,000 Damage to Premises Rented to You: $ 100,000 Any one premises Medical Expense: $ 5,000 Any one person Personal & Advertising Injury: $ 1,000,000 General Aggregate: $ 2,000,000 Products/Completed Operations Aggregate: Products-completed operations are subject to the General Aggregate Limit General Aggregate Limit applies per: Policy Description of Endorsements/Special Provisions Not applicable July 29, 2014 Authorized Representative Date CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 1 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Certificate of Commercial General Liability Insurance This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Named Insured: Excergy Corporation Insurer Name: Hiscox Insurance Company Inc. Policy Number: UDC-1263958-CGL-14 Type of Coverage: Occurrence Policy Effective Date: March 14, 2014 Policy Expiration Date: March 14, 2015 Limits of Insurance Each Occurrence: $ 1,000,000 Damage to Premises Rented to You: $ 100,000 Any one premises Medical Expense: $ 5,000 Any one person Personal & Advertising Injury: $ 1,000,000 General Aggregate: $ 2,000,000 Products/Completed Operations Aggregate: Products-completed operations are subject to the General Aggregate Limit General Aggregate Limit applies per: Policy Description of Endorsements/Special Provisions Not applicable Additional Insured Status ΠΠΠΠ Certificate holder maintains Additional Insured Status if this boxed checked. This certificate does not grant any coverage or rights to the certificate holder. If this certificate indicates that the certificate holder is an additional insured, the policy(ies) must either be endorsed or contain spe-cific language providing the certificate holder with additional insured status. The certificate holder is an additional insured only to the extent indicated in such policy language or endorsement. Cancellation In the event of cancellation of any policy described above, the insurer will attempt to mail 10 days written notice to the certificate holder prior to the effective date of cancellation. However, failure to do so will not impose any duty or liability upon the insurer, its agents or representatives, nor will it delay cancellation. CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 2 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 B2B Workforce July 29, 2014 Certificate Holder Date July 29, 2014 Authorized Representative Date CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 3 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Certificate of Commercial General Liability Insurance This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Named Insured: Excergy Corporation Insurer Name: Hiscox Insurance Company Inc. Policy Number: UDC-1263958-CGL-14 Type of Coverage: Occurrence Policy Effective Date: March 14, 2014 Policy Expiration Date: March 14, 2015 Limits of Insurance Each Occurrence: $ 1,000,000 Damage to Premises Rented to You: $ 100,000 Any one premises Medical Expense: $ 5,000 Any one person Personal & Advertising Injury: $ 1,000,000 General Aggregate: $ 2,000,000 Products/Completed Operations Aggregate: Products-completed operations are subject to the General Aggregate Limit General Aggregate Limit applies per: Policy Description of Endorsements/Special Provisions Not applicable Additional Insured Status ΠΠΠΠ Certificate holder maintains Additional Insured Status if this boxed checked. This certificate does not grant any coverage or rights to the certificate holder. If this certificate indicates that the certificate holder is an additional insured, the policy(ies) must either be endorsed or contain spe-cific language providing the certificate holder with additional insured status. The certificate holder is an additional insured only to the extent indicated in such policy language or endorsement. Cancellation In the event of cancellation of any policy described above, the insurer will attempt to mail 10 days written notice to the certificate holder prior to the effective date of cancellation. However, failure to do so will not impose any duty or liability upon the insurer, its agents or representatives, nor will it delay cancellation. CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 4 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 The City of Thornton July 29, 2014 Certificate Holder Date July 29, 2014 Authorized Representative Date CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 5 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Certificate of Commercial General Liability Insurance This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Named Insured: Excergy Corporation Insurer Name: Hiscox Insurance Company Inc. Policy Number: UDC-1263958-CGL-14 Type of Coverage: Occurrence Policy Effective Date: March 14, 2014 Policy Expiration Date: March 14, 2015 Limits of Insurance Each Occurrence: $ 1,000,000 Damage to Premises Rented to You: $ 100,000 Any one premises Medical Expense: $ 5,000 Any one person Personal & Advertising Injury: $ 1,000,000 General Aggregate: $ 2,000,000 Products/Completed Operations Aggregate: Products-completed operations are subject to the General Aggregate Limit General Aggregate Limit applies per: Policy Description of Endorsements/Special Provisions Not applicable Additional Insured Status ΠΠΠΠ Certificate holder maintains Additional Insured Status if this boxed checked. This certificate does not grant any coverage or rights to the certificate holder. If this certificate indicates that the certificate holder is an additional insured, the policy(ies) must either be endorsed or contain spe-cific language providing the certificate holder with additional insured status. The certificate holder is an additional insured only to the extent indicated in such policy language or endorsement. Cancellation In the event of cancellation of any policy described above, the insurer will attempt to mail 10 days written notice to the certificate holder prior to the effective date of cancellation. However, failure to do so will not impose any duty or liability upon the insurer, its agents or representatives, nor will it delay cancellation. CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 6 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 The City of Burbank July 29, 2014 Certificate Holder Date July 29, 2014 Authorized Representative Date CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 7 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Certificate of Commercial General Liability Insurance This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Named Insured: Excergy Corporation Insurer Name: Hiscox Insurance Company Inc. Policy Number: UDC-1263958-CGL-14 Type of Coverage: Occurrence Policy Effective Date: March 14, 2014 Policy Expiration Date: March 14, 2015 Limits of Insurance Each Occurrence: $ 1,000,000 Damage to Premises Rented to You: $ 100,000 Any one premises Medical Expense: $ 5,000 Any one person Personal & Advertising Injury: $ 1,000,000 General Aggregate: $ 2,000,000 Products/Completed Operations Aggregate: Products-completed operations are subject to the General Aggregate Limit General Aggregate Limit applies per: Policy Description of Endorsements/Special Provisions Not applicable Additional Insured Status ΠΠΠΠ Certificate holder maintains Additional Insured Status if this boxed checked. This certificate does not grant any coverage or rights to the certificate holder. If this certificate indicates that the certificate holder is an additional insured, the policy(ies) must either be endorsed or contain spe-cific language providing the certificate holder with additional insured status. The certificate holder is an additional insured only to the extent indicated in such policy language or endorsement. Cancellation In the event of cancellation of any policy described above, the insurer will attempt to mail 10 days written notice to the certificate holder prior to the effective date of cancellation. However, failure to do so will not impose any duty or liability upon the insurer, its agents or representatives, nor will it delay cancellation. CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 8 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 The City of Fort Collins July 29, 2014 Certificate Holder Date July 29, 2014 Authorized Representative Date CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 9 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Certificate of Professional Liability Insurance This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Named Insured: Excergy Corporation Insurer Name: Hiscox Insurance Company Inc. Policy Number: UDC-1263958-EO-14 Policy Effective Date: March 14, 2014 Policy Expiration Date: March 14, 2015 Limits of Insurance Each Claim: $ 1,000,000 Each Claim Aggregate for all Claims: $ 1,000,000 Aggregate for all Claims Deductible: $ 1,000 Each Claim Retroactive Date: March 01, 2012 The policy referred to in this certificate was issued on a claims made and reported basis. Description of Endorsements/Special Provisions Not applicable July 29, 2014 Authorized Representative Date DPL C001 CW (01/10) Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 1 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Certificate of Professional Liability Insurance This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Named Insured: Excergy Corporation Insurer Name: Hiscox Insurance Company Inc. Policy Number: UDC-1263958-EO-14 Policy Effective Date: March 14, 2014 Policy Expiration Date: March 14, 2015 Limits of Insurance Each Claim: $ 1,000,000 Each Claim Aggregate for all Claims: $ 1,000,000 Aggregate for all Claims Deductible: $ 1,000 Each Claim Retroactive Date: March 01, 2012 The policy referred to in this certificate was issued on a claims made and reported basis. Description of Endorsements/Special Provisions Not applicable DPL C001 CW (01/10) Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 2 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Additional Insured Status ΠΠΠΠ Certificate holder maintains Additional Insured Status if this boxed checked This certificate does not grant any coverage or rights to the certificate holder. If this certificate indicates that the certificate holder is an additional insured, the policy(ies) must either be endorsed or contain spe-cific language providing the certificate holder with additional insured status. The certificate holder is an additional insured only to the extent indicated in such policy language or endorsement. Cancellation In the event of cancellation of any policy described above, the insurer will attempt to mail 10 days written notice to the certificate holder prior to the effective date of cancellation. However, failure to do so will not impose any duty or liability upon the insurer, its agents or representatives, nor will it delay cancellation. B2B Workforce July 29, 2014 Certificate Holder Date July 29, 2014 Authorized Representative Date DPL C001 CW (01/10) Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 3 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Certificate of Professional Liability Insurance This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Named Insured: Excergy Corporation Insurer Name: Hiscox Insurance Company Inc. Policy Number: UDC-1263958-EO-14 Policy Effective Date: March 14, 2014 Policy Expiration Date: March 14, 2015 Limits of Insurance Each Claim: $ 1,000,000 Each Claim Aggregate for all Claims: $ 1,000,000 Aggregate for all Claims Deductible: $ 1,000 Each Claim Retroactive Date: March 01, 2012 The policy referred to in this certificate was issued on a claims made and reported basis. Description of Endorsements/Special Provisions Not applicable DPL C001 CW (01/10) Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 4 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Additional Insured Status ΠΠΠΠ Certificate holder maintains Additional Insured Status if this boxed checked This certificate does not grant any coverage or rights to the certificate holder. If this certificate indicates that the certificate holder is an additional insured, the policy(ies) must either be endorsed or contain spe-cific language providing the certificate holder with additional insured status. The certificate holder is an additional insured only to the extent indicated in such policy language or endorsement. Cancellation In the event of cancellation of any policy described above, the insurer will attempt to mail 10 days written notice to the certificate holder prior to the effective date of cancellation. However, failure to do so will not impose any duty or liability upon the insurer, its agents or representatives, nor will it delay cancellation. The City of Thornton July 29, 2014 Certificate Holder Date July 29, 2014 Authorized Representative Date DPL C001 CW (01/10) Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 5 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Certificate of Professional Liability Insurance This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Named Insured: Excergy Corporation Insurer Name: Hiscox Insurance Company Inc. Policy Number: UDC-1263958-EO-14 Policy Effective Date: March 14, 2014 Policy Expiration Date: March 14, 2015 Limits of Insurance Each Claim: $ 1,000,000 Each Claim Aggregate for all Claims: $ 1,000,000 Aggregate for all Claims Deductible: $ 1,000 Each Claim Retroactive Date: March 01, 2012 The policy referred to in this certificate was issued on a claims made and reported basis. Description of Endorsements/Special Provisions Not applicable DPL C001 CW (01/10) Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 6 HISCOX INSURANCE COMPANY INC. (A Stock Company) 233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601 Additional Insured Status ΠΠΠΠ Certificate holder maintains Additional Insured Status if this boxed checked This certificate does not grant any coverage or rights to the certificate holder. If this certificate indicates that the certificate holder is an additional insured, the policy(ies) must either be endorsed or contain spe-cific language providing the certificate holder with additional insured status. The certificate holder is an additional insured only to the extent indicated in such policy language or endorsement. Cancellation In the event of cancellation of any policy described above, the insurer will attempt to mail 10 days written notice to the certificate holder prior to the effective date of cancellation. However, failure to do so will not impose any duty or liability upon the insurer, its agents or representatives, nor will it delay cancellation. The City of Burbank July 29, 2014 Certificate Holder Date July 29, 2014 Authorized Representative Date DPL C001 CW (01/10) Includes copyrighted material of Insurance Services Office, Inc., with its permission. © ISO Properties, Inc., 2000 Page 7 Hiscox Insurance Company Inc. Policy Number: Named Insured: Endorsement Number: Endorsement Effective: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II – Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. UDC-1263958-CGL-14 Excergy Corporation 21 July 28, 2014 The City of Fort Collins 700 Wood Street Fort Collins,CO 80522