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HomeMy WebLinkAbout590755 SAVATREE LLC - INSURANCE CERTIFICATE (4)A4C"RL7CERTIFICATE OF LIABILITY INSURANCE 6/30/2020 DAT6/30/) -- 020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGA#IVELY 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 HOLnER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ie`s) inust-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 Exchange Street Buffalo, NY 14210 INSURED SavATree LLC and all related DBA's 550 Bedford Road Bedford Hills NY 10507 CnVFRA(:FR rCDTICIr ATC ultMCtD.. c n�i.mnu u, uas�a: 11 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS --------- _ - ----- ---- LISTED BELOW HAVE BEEN_ ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - �S TYPE OF INSURANCE ADDL wSD SUER VIVID POLICYNUMBER POLICY EFF (MMIDDIYYM POLICY EXP I 1MM1DDrfYY.Y)LIMITS A r/ cOMMERCLALGENERALLIABILRY CLAIMS -MADE F./-I OCCUR XCU INCLUDED ,/ ✓ GLO0'81388 7/1/2020 7/1/2021 EACH OCCURRENCE $2000000 TO KLNTEIJ PREMISES Ea occumence $1 000 000 ✓ MED EXP (An one person) $10 000 ✓ BLKT..CONTRACTUAL PERSONAL A ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ✓� ECOT LOC OTHER: GENERAL AGGREGATE $4,000,060 PRODUCTS - COMP/OPAGG $4000000 $ A D AUTOMOBILE LIABILITY ANY AUTO OWNED AUTO ONLY AUTOSULED HIRED I AUTOS ONLY ✓ AUTOS ONLY 50 COMP ✓ 500 COLL ✓ ✓ BAP 0381389 H020E�CZ02FH21V - 7/1/2020 7/1/2020 7/1/2021 7/1/2021 Ee BINEDLSINGLE LIMIT $2 000 000 ✓ BODILY INJURY (Per person) $ ✓ ✓ ✓ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Excess Auto $ 3 000 000 B ✓ UMBRELLALUB EXCESS LIAB ,i OCCUR CLAIMS -MADE ✓ ✓ AUC0178816 7/1/2020 7/1/2021 EACH OCCURRENCE $20000000 AGGREGATE $ 20 000 000 DED I ✓ I RETENTION$10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED9 ❑N (Mandatory in NH) H yes, describe le under DESCRIPTION OPERATIONS below NIA ✓ WC 0381387 7/1/2020 7/1/2021 ,i �srnruTE ER"_ E.L. EACH ACCIDENT $1 000 000. E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 C CONTRACTOR'S EQUIPMENT ($10,600 Deductible) MACO 7225 7/1/2020 7/1/2021 LEASED/RENTED $250,000 SCHEDULED $12,254,175 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional See attached acord 101 Remarks Schedule, may be attached if more space Is required) GGK I IFIGA I t: HOLULK I CANCELLATION City of Fort Collins SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Purchasing Director ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 580 Fort Collins CO 80522 AUTHORIZED _ED REP _ _.._R. _ -- ESENTATNE Michael Bonetto ©19.88-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD i ame and logo are registered marks of ACORD 56285D66 1 153241 1 2020-21 Certificate of Liability I Michael Scazcello 16,30/2020 10:46:04 M (EDT) I Page 1 of 2 AC RO® ADDITIONAL AGENCY CUSTOMER ID: LOC #: 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 0361388 I CARRIER NAIL CODE Zurich American Insurance C.O. 16535.. _ EFFECTNE 6ATE:7/1/2020 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO CORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Lability (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 InsurerOwners, Lessees or Contractors -Scheduled Person or Organization CG 20 26 (04/13) ADDL INSD-DESIGNATED PERSON/ORGANIZATION CG 20 37 (04/13) Additional Insure owners, Lessees or Contractors -Completed Operations CG 25 03 (05/09)Designated Construction Project(s) General Aggregate Limit CG 25 04 (05/09) DESIGNATED LOCATIbNIS GENERAL AGGREGATE Automobile Liability: CA 20 01 (10/13) ADDL INSD-LESSOR U-CA-387-A 07-94 SCHEDULE OF LOSS AYEE(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 I U I tclnla,G, f t7 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 56285066 1153241 1 2020-21 Certificate of Liability I Michael Scarcello 1 6/30/2020 10:46:04 AM (EDT) I Page 2 of 2