HomeMy WebLinkAbout125353 SAFE SYSTEMS INC - INSURANCE CERTIFICATE (2)DATE (MM/DDIYYYY)
PRODACORDT UCER aazCERTIFICATE-1484 FAX )OFBLIzABILITYIsINSURAINICE/29/2006
CERTIFICATE DASAMATTER OFINFORMATION
Taggart &Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ta
9 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1600 Canyon Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. Box 147
Boulder, CO 80306 INSURERS AFFORDING COVERAGE NAIC #
INSURED Safe Systems Inc INSURER A: Arch Specialty (TRMS)
3640 Walnut INSURERS: Owners Insurance Co 32700
Boulder, CO 80301 11SURERC: Pinnacol Assurance 41190
INSURER D:
INSURER E:
COVERAGES
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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
DD'DATE
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
imminnNY)
POLICY EXPIRATION
DATE tMWDDNY1
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F-j] OCCUR
BSPKG2059901
10/01/2006
10/01/2007
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
g 100 r 00
MED EXP (Any one person)
$ 5 , 00
PERSONAL & ADV INJURY
$ 1,000,00(
GENERAL AGGREGATE
$ 2,000,00(
PRODUCTS -COMP/OP AGG
$ 2,000,00(
GENT AGGREGATE LIMIT APPLIES PER:
POLICY PECTRO LOC
X J
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIREDAUTOS
NON -OWNED AUTOS
44042OS700
10/01/2006
16/01/2007
COMBINED SINGLE LIMIT
(Ea accident)
$
1,000,000
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHERTHAN EAACC
AUTO ONLY: AGG
$
$
EXCESS/UMBRELLA LIABILITY
OCCUR FD CLAIMS MADE
DEDUCTIBLE
RETENTION $
EACH OCCURRENCE
$
AGGREGATE
$
$
$
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
1747952
04/01/2006
04/01/2007
X I WC STATUS OTH-
E.L. EACH ACCIDENT
$ 100,00(
E.L. DISEASE - EA EMPLOYEE
$ 100,00(
E.L. DISEASE - POLICY LIMIT
1 $ 500,00(
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Fort Collins
Attn. Accounts Payable
PO Box S80
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Connie Arellano
ACORD 26 (2001108) VAOVKU cUKFUKA I wN 11066
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 26 (2001/08)