HomeMy WebLinkAboutSAFEBUILT LLC - INSURANCE CERTIFICATESAFEB-1 OP ID: AP
.ft O CERTIFICATE OF LIABILITY INSURANCE
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DATE 11/04/2014
11/04/2014
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 endoreemen s .
PRODUCER
RBN & Associates, Inc.
303 East Wacker Or Suite 1130
CONTACT
NAME:
IA/Nco"rio Eat : 312-856-9400 FAX No): 312$56-9425
Chicago, IL 60601
Bruce Scodro
ADDRESS:
INSURE $ AFFORDING COVERAGE
NAIL$
INSURER A: Prop & Casu Ins Co of Hartford
34690
INSURED SAFEbuilt Holding Company
INSURER B: Everest National Ins. Co.
SAFEbuilt, LLC
3755 Precision Drive, Ste 140
INSURER C: Executive Risk Indemnity, Inc.
35181
Loveland, CO 80538
INSURER D:
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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
LTft
TYPE OF INSURANCE
POLICY NUMBER
NIM/DDD�
MM/DDY EXP
LIMITS
B
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,00
CLAIMS MADE PC] OCCUR
CFBGL00003-141
10/03/2014
10/03/2015
PREMISES Ea ocwnence
$ 300,00
MED EXP (Any one pmem)
$ 10,00
PERSONAL &ADV INJURY
$ 1,000,00
AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
$ 2,000,00
GEN'L
X
POLICY JEST LOG
PRODUCTS -COMP/OPAGG
$ 2,000,00
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea accident
$ 1,000,00
X
BODILY INJURY (Per person)
E
A
ANY AUTO
83 UEN PY9100
10/03/2014
10/03/2015
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Par ecciderr)
$
X
X NON -OWNED
HIRED AUTOS AUTOS
PROPERTYDAMAGE
Per accident
$
E
X
UMBRELLA UAS
X
OCCUR
EACH OCCURRENCE
E 5,000,00
AGGREGATE
$ 5,000,00
B
IEXCESSLINB
CLAIMS -MADE
CFSEXOOOOI-141
10/03/2014
10/03/2015
DEO RETENTION$
$
WORKERS COMPENSATION
LI
AND EMPLOYERS ABILITY Y / N
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
NIA
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
(Mandatory In NH)
tt yea, deauiice under
E. L. DISEASE -POLICY LIMIT
E
OE SCRIPTION OF OPERATIONS b I.
C
Professional Liab/
8241-5262
10/03/2014
10/03/2015
Ea Claim 5,000,00
Cyber Liability
DED $50,000
Aggregate 5,000,00
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Addidonal Re na" Schedule, may M adached"mom apace Is required)
City of Fort Collins is an additional insured as respects General Liability
and Automobile Liability as required by a written contract
Fax# 970-221-6707
City of Fort Collins
PO Box 580
Fort Collins, CO 80522
N"1 91=
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORD:ED REP/RES�ENT�ATNE
?5 —!s' y
ACORD 25 (2014101)
01988-2014 ACORD
The ACORD name and logo are registered marks of ACORD
All riahts reaamad
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