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HomeMy WebLinkAboutSAVATREE LLC - INSURANCE CERTIFICATECERTIFICATE HOLDER ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC PRO- POLICY GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201005).01 6/23/2017 Key Insurance & Benefits Services 726 Exchange Street Suite 900 Buffalo NY 14210 Sarah Russell (716)819-5500 (716)819-5140 sarah.russell@key.insurance SavATree, LLC and all related DBA's 550 Bedford Road Bedford Hills NY 10507 Zurich American Insurance Co. 16535 American Guarantee & Liability 26247 Great American Insurance Co. 22136 17-18 NTI LIAB (Master) A X X X XCU INCLUDED X BLKT. CONTRACTUAL X X X GLO 0381388 7/1/2017 7/1/2018 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 A X X X X $250 COMP X X $500 COLL X X BAP 0381389 7/1/2017 7/1/2018 2,000,000 PHYSICAL DAMAGE A.C.V. B X X X 10,000 X X AUC 0178816 7/1/2017 7/1/2018 20,000,000 20,000,000 A N X WC 0381387 7/1/2017 7/1/2018 X 1,000,000 1,000,000 1,000,000 C CONTRACTOR'S EQUIPMENT MAC0247225 7/1/2017 7/1/2018 LEASED/RENTED $250,000 ($10,000 Deductible) SCHEDULED $5,912,075 DESCRIPTION The City OF of OPERATIONS Fort Collins / LOCATIONS / is VEHICLES an Additional (Attach ACORD 101, Insured Additional Remarks on a Schedule, primary if more space and is non-required) contributory basis in regard to the above General Liability and Automobile Liability 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-F Edition date 04/14, U-GL-1345-B CW Edition date 04/13, WC000313 Edition date 04/84. M Bonetto/SJAROS City of Fort Collins PO Box 580 Fort COllins, CO 80522