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HomeMy WebLinkAbout210454 PALMETTO SOLAR City of Wheat Ridge CO Building Dept_COI_Palmetto Solar LLC_05_25.2022 (1)Al� �R1 ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/Y) 05/25/20222022 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 McGriff Insurance Services, Inc. P.O. Box 10265 CONTACT Lindsay Tidmore NAME: (A/C, No EExt):800-476-2211 FAX No): E-MAIL Itidmore me riff.com ADDRESS: g Birmingham, AL 35202 INSURER(S) AFFORDING COVERAGE NAIC # 1000090663211 INSURERA:Starr Indemnity & Liability Company 38318 EACH OCCURRENCE INSURED Palmetto Solar, LLC INSURER B :Allied World Assurance Company (U.S.) Inc. 19489 INSURER C: 1505 King Street Ext, Ste. 200 Charleston, SC 29405 INSURER D DAMAGE TORENTED PREMISES Ea occurrence INSURER E: MED EXP (Any one person) $ 5,000 INSURER F: COVERAGES CERTIFICATE NUMBER:ZHRLHU3J 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 1000090663211 08/19/2021 08/19/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE TORENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO X LOC PRODUCTS - COMP/OP AGG $ 1,000,000 Per Location Aggregate $ 2,000,000 OTHER: A AUTOMOBILE LIABILITY 1000636154211 08/19/2021 08/19/2022 COMBINED SINGLE LIMIT Ea accident $ 1 ,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ A UMBRELLA LIAB XOCCUR 1000095527211 08/19/2021 08/19/2022 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 X EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ Products Aggregate $ 10,000,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) N I A 100 0004745 08/19/2021 08/19/2022 X I PER OTH- S TATUTE I I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Technology E&O 03130260 08/19/2021 08/19/2022 Occurrence $ 5,000,000 Aggregate $ 5,000,000 Cyber Crime $ 100,000 Retention $ 100,000 $ DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Wheat Ridge City Hall Building Dept. AUTHORIZED REPRESENTATIVE 7500 W. 29th Ave. Wheat Ridge, CO 80033 ACORD 25 (2016/03) Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i OOR� COLORADO Department of Regulatory Agencies Division of Professions and Occupations Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time by visiting www.colorado.gov/dora/DPO_Print_License and following the instructions listed. If you would like a more durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastore@nasba.org. Should you have questions about your credential, or need other information please contact our Customer Service Team at 303-894-7800 or dora_dpo_licensing@sLate.co.us. Division of Professions and Occupations Bectrical Board Palmetto Solar, LLC Bectrical Contractor R-- 0101589 10/01/2020 Number Issue Date Active 09/30/2023 Credential Status Expire Date Verify this credential at: dpo.colorado.gov (/J lorado Department of RegulatoryAgenc Division of Professions and Occupations Bectrical Board Palmetto Solar, LLC Bectrical Contractor x,0101589 10/01/2020 Number Issue Date Active 09/30/2023 Credential Status Expire Date Vefify this credential at: dpo.colorado.gov Division Director: Ronne Hines 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 F 303.894.7693 dpo.colorado.gov C DOHA COLORADO Department of Regulatory Agencies Division of Professions and Occupations Below are your electronic wallet cards to use as proof of your license. You can also print your license at any time by visiting vvww.cotorado.gov/dora/DPO_Print_License and following the instructions listed. If you would like a more durable wallet card option, you can order one for a fee by visiting www.nasbastore.org and selecting the "Colorado License Cards" link on the left hand side of the page. If you prefer, you can also contact NASBA by phone at 1-888-925-5237 or by email at nasbastore@nasba.org. Should you have questions about your credential, or need other information please contact our Customer Service Team at 303-894-7800 or dora_dpo_licensing@state.co.us. lorado Department of Regulatory Agenc Division of Professions and Occupations Bectrical Board Fbssell Phillip Kill Master Bectrician M E0601399 10/01/2020 Number Issue Date Active 09/30/2023 Credential Status Expire Date Verify this credential at: www.cotorado.gov/dora/po Division Director ,Ronne Hines Credential Holder Signature lorado Department of Regulatory Agenc Division of Professions and Occupations Bectrical Board Bissell Phillip Kill Master Bectridan M E0601399 10101 / 2020 Number Issue Date Active 09/30/2023 Credential Status Expire Date Verify this credential at: www.cotorado.gov/dora/dp 1 �'A4111,!& ,--- I ;;; -u l Z� Division Director Ronne Hines Credential Holder Signature g ' C .\ 1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800 f 303.894.7693 dpo.colorado.gov