HomeMy WebLinkAbout125353 SAFE SYSTEMS INC - INSURANCE CERTIFICATE (11)ACORD CERTIFICATE OF LIABILITY INSURANCE
,r
DATE(MWDDlYYYY)
09/29/2011
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 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 endomement(s).
PRODUCER
Berrien Insurance Group, Inc.
385 Inverness Parkway
St. 280
Englewood, CO 80112
CONTACT
NAME: Alice Giacalone
FAX
AICNoE :303.795.5831 MC. W): 303. 795. 5833
A-MA!IL 5:
INSURER(SI AFFORDING COVERAGE
NAIC IN
INSURER A: First Mercury Insurance Co
10657
INSURED Sae Systems, Inc
421 S Pierce Ave
Louisville, CO 80027
INSURERB: Scottsdale Insurance Company
41297
INSURERC: National Fire Ins. of Hartford
20478
INSURER D:
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 11-12 Certificates 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
INSR
MD
POLICY NUMBER
MMI
I (MWDDNYM
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
X Errors & Omissions
FMMI020814-
10/01/2011
10/01/2012
EACH OCCURRENCE
$ 1,000,00
PREMISES Ea=nrence
$ 50,00
MEDEXP(Any onePawn)
$ 5,00
PERSONAL aADVINJURY
$ 1,000,00
GENERALAGGREGATE
$ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO LOC
JECT
PRODUCTS - COMP/OP AGG
$ 2,000,00
$
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIREDAUTOS X NON -OWNED
AUTOS
402643279
10/01/2011
10/01/2012
Ea a=wrt
s 1,000,00
BODILY INJURY (Per person)
$
BODILY INJURY (Per awdenl)
S
Pe' awwm
S
S
B
X
UMBRELLAUJB
EXCESS UAB
X
OCCUR
CLAIMS -MADE
XLS007734
10/01/2011
10/01/2012
EACH OCCURRENCE
$ 8,000,00
AGGREGATE
$ 8,000,00
DED I I RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUI
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
UII yea,dear Umer
DESCRIPTION OF OPERATIONSMIM
NIA
-
TORY LIMITS ER
E.L. EACH ACCIDENT
$
E.L DISEASE - EA EMPLOYE
$
E.L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (AttaO ACORD IOI, AMMonal Remade Schedule, u =. space is rqulnfdl
vidence of Insurance.
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 Fort Collins
PO Box 580
Fort Collins. CO 80522
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD