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HomeMy WebLinkAbout210507 ENERGY SYSTEMSCity Of wheatride... O� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/04/2022 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 CUNIAGI NAME: Dain Priday Rubix Insurance Solutions PHONE 303 993-3300 (A/C, No, Ext): (AIC, No): ADDRESS: dainCdrubixinsurance.com 5303 E Evans Ave #104 INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 1,000,000 Denver CO 80222 INSURERA: Travelers Group 36137 INSURED INSURER B : Pinnacol Assurance 524210 Energy System INSURER C : INSURER D 4301 DEL RIO CT INSURER E AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS XHIRED �/ NON -OWNED AUTOS ONLY I► AUTOS ONLY DENVER CO 80239 INSURER F: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F X] OCCUR x y 0045810213 07/15/2022 07/15/2023 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F—] PE� LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS XHIRED �/ NON -OWNED AUTOS ONLY I► AUTOS ONLY 0045810213 07/15/2022 07/15/2023 (Ea accident) IGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Per accident) $ UMBRELLA UAB EXCESS LAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATIONY/ N ND EMPLOYERS' LIABILITY ANY PRO PRI ETOR/PARTN ER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA y 4235040 01/28/2022 02/01/20223 - 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 if more space is required) CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 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 City of Wheat Ridge ACCORDANCE WITH THE POLICY PROVISIONS. 7500 W. 29th Ave, AUTHORIZED REPRESENTATIVE Wheat Ridge, CO 80033 Dat.+ J Pri Alay ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Colorado Department of Regulatory Agencies Division of Professions and Occupations Electrical Board Energy Systems LLC Electrical Contractor EC.0102308 Number Active Credential Status Verify this credential at: Division Director Ronne Hines 02/01/2022 Issue Date 09/30/2023 Expire Date dpo.colorado.gov Credential Holder Signature Colorado Department of Regulatory Agencies Division of Professions and Occupations A Electrical Board Jared K Kraft 4s Master Electrician M E.0025474 11/18/2021 Number Issue Date Active 09/30/2023 . 4 � Credential Status "L,`° Expire Date Verify this credential at: dpoxolorado.gov A Division DirectorbRonne Hines Credential Bolder Signature