HomeMy WebLinkAbout125353 SAFE SYSTEMS INC - INSURANCE CERTIFICATE (16)``� br CERTIFICATE OF LIABILITY INSURANCE
DATE MMIDDIYYYY
4/17/2014 )
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 endorsement(s).
PRODUCER
CONTACT Victoria Palmer
NAME:
PHONE (303)442-1484 Fax .(303)442-0022
Taggart & Associates, Inc.
1600 Canyon Boulevard
-MAIL ;vpalmer®taggartiaeTLraace.com
OR
INSURERS AFFORDING COVERAGE
NAICM
P. O. BOX 147
INSURER A:Pinnacol Assurance
41190
Boulder CO 80306
INSURED
INSURER B
-3
Safe Systems, Inc. ��rj353
INSURERC:
INSURER O:
421 S. Pierce Avenue ✓
INSURER E :
INSURER F:
Louisville CO 80027
COVERAGES CERTIFICATE NUMBER:14-15 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 INSURANCEADDLSUBR
POLICY NUMBER
POLICY EFF
MMIDDIYYYY1
POLICY UP
JMWDDrrfYYI
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F-IOCCUR
EACH OCCURRENCE
$
$
MED EXP (Any one parson)
$
PERSONALS ACV INJURY
$
GENERAL AGGREGATE
$
GENT AGGREGATE
POLICY
LIMIT APPLIES PER:
PRO- LOC
PRODUCTS - COMP/OP AGO
$
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
COMBINED N L 1
Ea derall
BODILY INJURY (Per person)
$
BODILY INJURY(PeraxidaM)
$
PROPERTY DAMAGE
P 0 f
$
f
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DELI I I RETENTION
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LMAILITY YIN
ANY PROPRIErORIPARTNERIEXECUTIVEO
OFFICERIMEMBER EXCLUDED?747952
(Mandatory In NH)
Use describe under
DESCRIPTION OF OPERATIONS on.
NIA
/1/2014
/1/2015
X WC STATU- OTH-
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 11000,000
E.L. DISEASE -POLICY LIMIT
$ 1,000 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks 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, CIC/BHB uLfflft,&Al � . cv ate"'
01988-2010 ACORD CORPORATION. All riohts reserved.
INSO25 nnlnmA n1 Tha AGnan nano unrl Innn arc, rnnictiarnH mairtrc nF ACnan