HomeMy WebLinkAbout125353 SAFE SYSTEMS INC - INSURANCE CERTIFICATE (14)v CERTIFICATE OF LIABILITY INSURANCE
DATE (MhVDD YYYVI
3/20/2013
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
i 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 ",. ". ;.,. _.. _.. _.. .....
Taggart. 6. Associates,' Inc.
.,:a n .�. . -
1600 Canyon Boulevard '
CONTACT Courtney Gabriel; PWCAM
PHONE (3O3) 442-1484 No o (303) 442-8822'-'
E-MVL'.courtneyg@taggartinsurance.com -
INSURER 5 AFFORDING COVERAGE
NAIC If
P. O. � BOX 147
INSURERA:Pinnacol Assurance
41190
Boulder CO 80306
INSURED K
INSURER B:
INSURERC:
Safe Systems, Inc.
INSURER D:
421 S. Pierce Avenue
INSURER E
INSURER F:
Louisville CO 80027
COVERAGES CERTIFICATE NUMBER:13-14 Master 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
SU..
POLICY NUMBER
POLICY EFF
MM/DD/YYYYt
POLICY EXP
IMM/DD(YYYY1
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
PREMISES Ea occurrence
$
COMMERCIAL GENERAL LABILITY
CLAIMS -MADE ❑ OCCUR
MED EXP (Any one Person)
$
PERSONAL S ADV INJURY
$
GENERAL AGGREGATE
$ t'
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG
$
1 -� -
� - -
.....
...
POLICY _ PRO- LOG'
IFQT
-.-
.AUTOMOaCOMBINED
,ANV AUTO ..,4
,ALL OWNED SCHEDULED:
- AUTOS AUTOS .
-
-
_
SINGLE 'LIMIT --
ecndem
— --- - - - _.._
BODILY INJURY
BODILY INJURY(Per accident)
It
PROPERTY DAMAGE-
Per accident � - �-�
$ :-.
- - - -- .-
_
' NON -OWNED -
..� HIRED AUTOS ' � AUTOS
..
- '
$
UMBRELLA LAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LAB
CLAIMSWADE
DED RETENTION$
$
jA
WORKERS COMPENSATION
AND EMPLOYERS' LABILITY YIN
X WC STATDRY LIMU- OTH-
FR
ANY PROPRIETOR/PARTNER/EXECUTIVE
/M OFFICEREMBER EXCLUDED?
(Mandatory in NH)
N/A
747952
/1/2013
/1/2014
E.L. EACH ACCIDENT
$ 500,000
E.L. DISEASE - EA EMPLOYEE
It 500,000
K ye5, deswt78 Under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD tot, Additional Renarks Schedule, If more space is required)
City of Fort Collins
PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Gabriel, PWCAM/HDC C,y-XW" Q- CeAWII,"
ACORD 25 (2010/05)
INS025 (201005).01 The ACORD name and logo are registered marks of ACORD