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HomeMy WebLinkAbout590755 SAVATREE LLC - INSURANCE CERTIFICATE.4CO2�a CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6126/2019 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). USI Insurance Services 726 Exchan a Street Buffalo, NY �4210 CONTPRODUCER NAME: Michael Scarcello PHONE FAX A/c N E : 716-314-2000 A/c No): 716-314-2199 E-MAIL ADDRESS: mlchael.SCarcell0 usl.COm INSURERS AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Co. 16535 INSURED SavATree, LLC and all related DBA's INSURERB: American Guarantee & Liability 26247 INSURERC: Great American Insurance Co. 16691 INSURER D : Navigators Insurance Company 42307 550 Bedford Road Bedford Hills NY 10507 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 49562187 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. ILTR LTRINSD TYPE OF INSURANCE ADDL'I WVD POLICY NUMBER MMIDDPOLICY EFF POLICY EXP LIMITS A �/ COMMERCIAL GENERAL LIABILITY ✓ ✓ GLO0381388 7/1/2019 7/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR ✓ DAMAGE TO RENTED PREMISES Ea or $1,000,000 V MED EXP (Any one person) $ 10,000 XCU INCLUDED t/ BLKT. CONTRACTUAL PERSONAL & ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY ✓❑ JEC LOC PRODUCTS - COMP/OP AGG $ 2 000,000 $ �E OTHER: A AUTOMOBILE LIABILITY ✓ ✓ BAP 0381389 7/1/2019 7!1/2020 Ee BINEDtSINGLE LIMIT $2 000,000 BODILY INJURY (Per person) $ ✓ ANY AUTO OWNED AUTOS ONLY AUTOSULED ✓ BODILY INJURY (Per accident) $ D ✓ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY kv H019EXCZ02FH21V 7/1/2019 7/1/2020 PROPERTYDAMAGE Per accident $ Excess Auto $3 000,000 vl $250 COMP $500 COLL B �/ UMBRELLA LIAB �/ OCCUR v/ v/ AUC 0178816 7/1/2019 7/1/2020 EACH OCCURRENCE $20 000 000 AGGREGATE $20,000,000 EXCESS LIAB CLAIMS -MADE DED ✓ I RETENTION $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N OFF ICER/MEMB REXCLUDED?ECUTIVE � NIA WC 0381387 7/1/2019 7/1/2020 H '/ STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT C CONTRACTOR'S EQUIPMENT MACO247225 7/1/2019 7/1/2020 LEASED/RENTED $250,000 ($10,000 Deductible) SCHEDULED $5,912,075 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) See attached acord 101 City of Fort Collins is included as an Additional Insured with respect to General Liability and Auto Liability as required by written contract. and a waiver of subrogation applies to the General Liability, Automobile Liability and Workers Compensation to the extent covered by endorsement form(s) U-GL-1175-F CW Edition date 04/13, U-CA-424-E NY Edition date 04/11, U-GL-1345-B CW Edition date 04/13, WC000313 Edition date 04/84. CERTIFICATE HOLDER CANCELLATION 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 `y Michael Bonetto ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 49562187 1153241 12019-20 Certificate of Liability I Michael Scarcello 1 6/26/2019 12:09:20 PM (EDT) I Page I of 2 AGENCY CUSTOMER ID: 153241 LOC #: ACC?R" ® ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED USI Insurance Services SavATree, LLC and all related DBA's 550 Bedford Road POLICY NUMBER Bedford Hills NY 10507 GLO 0381388 CARRIER NAIC CODE Zurich American Insurance Co. 16535 EFFECTIVE DATE:7/1/2019 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: City of Fort Collins ADDRESS: PO Box 580 Fort Collins CO 80522 To the extent covered by endorsement form(s): General Liability: CG 00 01 (04/13) COMMERCIAL GENERAL LIABILITY COV FORM U-GL-1175-F CW (04/13) Additional Insured -Automatic -Owners, Lessees or Contractors U-GL-1521-A CW (10/12) Blanket Notification to Others of Cancellation or Non -Renewal U-GL-1345-B CW (04/13) General Liability Supplemental Coverage Endorsement - Includes Waiver of Subrogation CG 20 10 (04/13) Additional Insured -Owners, Lessees or Contractors -Scheduled Person or Organization CG 20 26 (04/13) ADDL INSD-DESIGNATED PERSON/ORGANIZATION CG 20 37 (04/13) Additional Insured -Owners, Lessees or Contractors -Completed Operations CG 25 03 (05/09)Designated Construction Project(s) General Aggregate Limit CG 25 04 (05/09) DESIGNATED LOCATIONS GENERAL AGGREGATE Automobile Liability: CA 20 01 (10/13) ADDL INSD-LESSOR U-CA-387-A 07-94 SCHEDULE OF LOSS PAYEE(S) U-CA-832-A CW (01/13) BLANKET NOTIFCATION TO OTH CANC/NONREN U-CA-424-F NY (02/16) COVERAGE EXTENSION ENDT-NY Workers' Compensation: WC 00 03 13 (04/84) Blanket Waiver of Our Right to Recover from Others Endorsement WC 99 06 43 (01/13) Blanket Notification to Others of Cancellation or Non -Renewal ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 49562187 1 153241 1 2019-20 Certificate of Liability I Michael Scarcello 1 6/26/2019 12:09:20 PM (EDT) I Page 2 of 2