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HomeMy WebLinkAbout532726 SAFEBUILT COLORADO LLC - INSURANCE CERTIFICATEDATE (MM/DD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 9111 /27/zo18 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 have ADDITIONAL INSURED provisions or 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 NAME: RBN Insurance Services PHONE FAX 303 E Wacker Dr Ste 650 N xt : 312-856-9400 A/C No): 312-856-9425 Chicago IL 60601 ADDRESS: lnortz@rbninsurance.com I INSURER(S) AFFORDING COVERAGE I NAIC 0 1 INSURED SAFELLC-01 INSURERB: Hartford Casualty Insurance Co 29424 SAFEbuilt Holding Company SAFEbuilt, LLC (See Attached) INSURERC: Navigators Insurance Company 42307 3755 Precision Drive, Ste 140 INSURERD: Twin City Fire Insurance Co. 29459 Loveland CO 80538 INSURER E: Great American EBBS Ins. Co. 37532 INSURER F : COVFRAGES CERTIFICATE NUMBER: 8277. on57 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 ADOL SUER POLICY NUMBER MM/DDPOLICY /YYYY MM/ D1YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 83UENZV3951 10/3/2018 10/3/2019 EACH OCCURRENCE $1,000,000DAMAGE CLAIMS -MADE FxI OCCUR To RENTED PREMISES Ea occurrence) _ $ 300,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO ❑ LOC X JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 83UENPY9100 10/3/2018 10/3/2019 COMBINED SINGLE LIMIT Ea accident $ 1,0D0,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY C UMBRELLA LIAB X OCCUR CHI8EXC8856001V 10/3/2o18 1o/3/2019 EACH OCCURRENCE $10,000,000 X AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DIED X RETENTION $ n $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N 83WECE0623 5/12/2018 5/12/2019 PER OTH- STATUTE I I ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 O`rICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 E Professional Liability TER2475972 10/3/2018 1OW019 Each Claim/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Fort Collins is an Additional Insured as respects General Liability as required by a written contract or written agreemerRECEIVE V OCT 0 2 2018 City Manager's Office GLK 111-IGA I L HULULK GANGtLLA I IUN City of Fort Collins City Hall West 300 LaPorte Avenue Fort Collins CO 80521 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 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD LNORTZ 1 AFRO AGENCY CUSTOMER ID: SAFELLC-01 LOC #: O ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED BN Insurance Services SAFEbuilt Holding Company SAFEbuilt, LLC See Attached) POLICY NUMBER 3755 Precision Drive, Ste 140 SEE PAGE 1 Loveland, CO 80538 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Named Insureds (continued): SAFEbuilt Arizona, LLC SAFEbuilt Carolinas, LLC SAFEbuilt Colorado, LLC SAFEbuilt Florida, LLC SAFEbuilt Georgia, LLC SAFEbuilt Illinois, LLC SAFEbuilt Louisiana, LLC SAFEbuilt New Mexico, LLC SAFEbuilt Ohio, LLC SAFEbuilt Oregon, LLC SAFEbuilt Texas, LLC SAFEbuilt Michigan, LLC SAFEbuilt Washington, LLC SAFEbuilt Wisconsin, LLC LSL Planning, LLC Meritage Systems, Inc. If required by a written contract, the following forms apply on a blanket basis. Page 1 of 1 General Liability: Form HG0001 09 16 Additional Insureds; Primary and Non-contributory; Waiver of Transfer of Rights of Recovery Against Others to Us Auto Liability: HA9916 0312 Commercial Automobile Broad Form Endorsement includes Additional Insureds and Waiver of Subrogation Workers Compensation: WC 00 03 13 Waiver Of Our Right to Recover from Others ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD