HomeMy WebLinkAbout125353 SAFE SYSTEMS INC - INSURANCE CERTIFICATE (12)ACORD. CERTIFICATE OF LIABILITY INSURANCE
10/0 /2 04
PRODUCER (303)442-1484 FAX (303)442-8822
Taggart & Associates, Inc.
1600 Canyon Boulevard
y
P. 0. Box 147
Boulder, CO 80306
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED Safe Systems Inc
3640 Walnut
Boulder, CO 80301
INSURERA: Arch Specialty Insurance Co
INSURERB: Owners Insurance CO
32700
INSURERC. Pinnacol Assurance
41190
INSURER D:
INSURER E:
Cl1VPRA1:04
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
ADD`L
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
BSPKGZOS99
10/01/2004
10/01/200S
EACH OCCURRENCE
E 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
E 100,000
CLAIMS MADE FXI OCCUR
MED EXP (Anyone person)
$ S 0Q
A
X Errors & Omissions
PERSONAL& ADV INJURY
$ 1,000,00(
GENERAL AGGREGATE
$ 2,000,00(
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,00(
POLICY PRO- JECT LOC
AUTOMOBILE LIABILITY
X ANY AUTO
44042OS700
10/01/2004
10/01/2005
COMBINED SINGLE LIMIT
(Ea accident)
E
1,600,000
BODILY INJURY
(Per person)
$
B
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident)
E
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
E
GARAGE LIABILITY
AUTO ONLY- EA ACCIDENT
E
OTHER THAN EA ACC
$
ANY AUTO
S
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
E
OCCUR CLAIMS MADE
AGGREGATE
$
E
E
DEDUCTIBLE
$
RETENTION E
WORKERS COMPENSATION AND
17479S2
04/01/2004
04/01/200S
X I WCSTATU- OTH-
C
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECLYrIVE
E.L. EACH ACCIDENT
E 1OO OO
E.L. DISEASE - EA EMPLOYE
-
E 100,000
OFFICER/MEMBER EXCLUDED?
I es, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
I S 500 00
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
City of Fort Collins
256 W. Mountain Ave.
Fort Collins, CO 8OS22
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAR SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
Douglas Sollman CIC ARM/MAS
ACORD 25 (2001108) OACORD CORPORATION 1988