Loading...
HomeMy WebLinkAbout590755 SAVATREE LLC - INSURANCE CERTIFICATE (2)ACORUa C" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/26/2019 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). PRODUCER USI Insurance Services 726 Exchan e Street Buffalo, NY �4210 CONTACT NAME: Michael $CarCellO PHONE FAX a,/ No Ex : 716-314-2000 A/c No): 716-314-2199 E-MAIL ADDRESS: michael.scarcello@usi.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 INSURERD: Navigators Insurance Company 42307 550 Bedford Road Bedford Hills NY 10507 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 49562186 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 iADDL'SUBR POLICYNUMBER POLICY EFF POLICY EXP MM/DD/YYYY MMIDD/YYYY 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 occurrence $ 1 ,000,000 ✓ ME EXP (Anyone person) $ 10,000 XCU INCLUDED ✓ BLKT. CONTRACTUAL PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ✓❑ jE O LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY ✓ ✓ BAP 0381389 7/1/2019 7/1/2020 Ea BINEDlSwGLE LIMIT $2 00Q000 ✓ BODILY INJURY (Per person) $ ANY AUTO ✓ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ ID ✓ HIRENON-OWNED S ONLY ✓ AUTOS AUTO H019EXCZ02FH21V 7/1/2019 7/1/2020 ROaERd.rtA GE P $ Excess Auto $3 000 000 ✓ $250 COMP ✓ $500 COLL B ✓ UMBRELLA LIAB �/ OCCUR AUC 0178816 7/1/2019 7/1/2020 EACH OCCURRENCE $20,000,000 AGGREGATE $20,000,000 EXCESS LIAB CLAIMS -MADE DED ✓ RETENTION $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMB REXCLU EDANYPROPRIETORIPARTNER/EXECUTIVE r N / A ✓ WC 0381387 7/1/2019 7/1/2020 �/ SPER TATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE -POLICY LIMIT $1 000 000 - - -- - $ 1 000 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below C CONTRACTOR'S EQUIPMENT MACO247225 7/1/2019 711/2120 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 Purchasing Director P.O. 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 "I 10 Michael Bonetto ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 49562186 1153241 12019-20 Certificate of Liability I Michael Scarcello 16/26/2019 12:09:20 PM (EDT) I Page I of 2 AGENCY CUSTOMER ID: 153241 ACORO® LOC #: 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 Purchasing Director ADDRESS: P.O. 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 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 49562186 1153241 1 2019-20 Certificate of Liability I Michael Scarcello 1 6/26/2019 12:09:20 PM (EDT) I Page 2 of 2