HomeMy WebLinkAbout125353 SAFE SYSTEMS INC - INSURANCE CERTIFICATE (6)_ _ _ CERTIFICATE
A_COR.D,M
OF LIABILITY INSURANCE
DATE (MM/DD YYYY)
3/12/2009
PRODUCER (303) 442-1484 FAX: (303) 442-8822
Taggart & Associates, Inc.
1600 Canyon Boulevard
P. O. 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.
421 S. Pierce Avenue
Louisville CO 80027
INSURERA.Arch Specialty Insurance
INSURERS. Colorado Casualty
41785
wsURERCf Scottsdale Insurance
w RER D'. Pinnacol Assurance
41190
wsua_RE'.
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 PAD CLAIMa.
INSR
ADD'L
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYY
POLICY EXPIRATION
DATE MMIDDM
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE ❑X OCCUR
BSPKG2059904
10/1/2008
10/1/2009
EACH OCCURRENCE....__
$ 11000,000
DAMAGE TO RENTED
PREMI ESE. occurrence)_
$ 100, 000
MED EXP,(Any
$ 5, 000
_oneperson)
PERSONAL B ADV INJURY
$ 1,000, 000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE UMITAPPLIES PFR.
X POLICY JEOT LOC
PRODUCTS - COMPIOPA
$ 2,000,000
B
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIRED AUTOS
NON -OWNED AUTOS
BA8519737
10/l/2008
10/1/2009
COMBINED SINGLE LIMIT
(Ea accitlen0
$ 11000,000
X
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA A
AUTO ONLY. AGO
$
$
C
EXCESS/UMBRELLA LIABILITY
X OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION
XLS0054676
10/1/2008
10/1/2009
EACH OCC0RRFNCF
$ 9,000,000
AGGREGATE
$ 91000,000
$
$
D
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
yes, describe under S
SPECIAL PROVISIONS below
1747952
4/1/2009
4/1/2010
X. WC STATU- OTH-
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYEE
$ 100,000
E.L. DISEASE - POLICY LIMIT
$ 500,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONS(VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
City of Fort Collins
Attn. Accounts Payable
PO Box 580
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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
AUTHORIZED REPRESENTATIVE
41exandra Bush/AHB
nrnDn SR Nnn11n R1
INS025 pos).08a Page 1 of 2
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 25 (2001108)
INS025 (oios oaa Page 2 of 2