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HomeMy WebLinkAboutSAFEBUILT LLC - INSURANCE CERTIFICATE (2)SAFEB-1 OP ID: CL ACORO CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) `--� 10/05/2015 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 endorsement(s). PRODUCER NAME: CT C ndi LaMotte REIN 8, Associates, Inc. 303 East Wacker Dr Suite 1130 A/CNNo El:312-856-9400 Fa N, Chicago, IL 60601 ADDRESS: Bruce Scodro clamotte@rbn500.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Prop & Casu Ins Co of Hartford 34690 INSURED SAFEbuilt Holding Company INSURER B: Everest National Ins. Co. 10120 SAFEbuilt, LLC INSURER C: Executive Risk Indemnity, Inc. 35181 (See Attached) 3755 Precision Drive, Ste 140 INSURERD: Loveland, CO 80538 INSURER E : CnVFRAAFA CFRTIFICATF NI IMRFR• RFVIQIr)N NI IMRFR• 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 OL UB POLICY EFF POLICY NUMBER MM/DD POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY �CF8GL00003-151 EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE � OCCUR 10/03/2015 10/03/2016 AMA ES(RENTED PREMISES Ea occurrence) -- $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY l PE� LOC X PRODUCTS - COMP/OP AGG $ 2,000,00 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)$ 1,000,00 X BODILY INJURY (Per person) $ A ANY AUTO 83 UEN PY9100 10/03/2015 10/03/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X X NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 6,000,00 B EXCESS LIAB CLAIMS -MADE CF8EX00001-151 10/03/2015 10/03/2016 DIED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED'/ ❑ N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below _- - - $ E.L. DISEASE - POLICY LIMIT C IProfessional Liab/ 8241-5262 10/03/2015 10/03/2016 Ea Claim 5,000,00 C ilCyber Liability 8241-5262 10/03/2015 10/03/2016 Ea Claim 1,000,00 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 and Automobile Liability as required by a written contract Fax# 970-221-6707 L:tK I IrlllA I t MULUtK CITYOFF 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 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SAFEB-1 PAGE 2 NOTEPAD INSURED'S NAME SAFEbuilt Holding Company OP ID: CL Date 10/05/2015 gamed 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 LSL Planning, LLC eritage Systems, Inc. If required by a written contract, the following forms apply on a blanket basis. General Liability: CG2038 0413 Additional Insured -Owners, Lessees or Contractors CG2001 0413 Primary and Noncontributory CG2404 0509 Waiver of Transfer of Rights of Recovery Against Others to Us to Liability: 9916 0312 Commercial Automobile Broad Form Endorsement includes ditional Insureds and Waiver of Subrogation