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HomeMy WebLinkAbout590755 SAV A TREE LLC - INSURANCE CERTIFICATE (2)AC� 0 r ATE (MM/DDIYYYY) C CERTIFICATE OF LIABILITY INSURANCE 6/28/2018 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 NAME: Sarah Russell 726 Exchange Street PHONE 716-819-5678 FAX No: Buffalo, NY 14210 E-MAIL — -- ADDRESS: Sarah.Russell@key. insurance INSURER(S) AFFORDING COVERAGE NAIC N INSURED SavATree, LLC and all related DBA's 550 Bedford Road Bedford Hills NY 10507 INSURER A: Zurich American Insurance Co. 16535 INSURER B: American Guarantee & Llablllt 26247 INSURERC: Great American Insurance Co. 22136 INSURERD: _ INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 49ARA'171 RFVISInN NIIMRFR- 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 TYPE OF INSURANCE INSD SWVD UER POLICY NUMBER POLICY YYY MMLDD/YYYY LIMITS A �/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE + OCCUR XCU INCLUDED ✓ ✓ GLO0381388 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000000 PREMISES Ea occurrence $ 1 000 000 ✓ MED EXP (Any one person) $ 10,000 ✓ BLKT. CONTRACTUAL PERSONAL & ADV INJURY $ 1,000 000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY jERa7 LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS -COMP/OP AGG $ 2,000 000 $ A AUTOMOBILE ✓ ✓ ✓ ✓ LIABILITY ANY AUTO OWNED AUTOS ONLY AUTODULED HIRED NON -OWNED AUTOS ONLY ✓ AUTOS ONLY $250 COMP ✓ $500 COLL ✓ ✓ BAP 0381389 7/1/2018 7/1/2019 MBINE SINGLE LIMIT Ea accident $ 2 000 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ Physical Damage _ $A.C.V. B �/ UMBRELLA LIAB EXCESS LIAB ✓ OCCUR CLAIMS -MADE ✓ ✓ �AUC 0178816 7/1/2018 7/1/2019 EACH OCCURRENCE $20,000000 AGGREGATE $20,000000 DED I ✓ I RETENTION $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A ✓ WC 0381387 7/1/2018 7/1/2019 I ✓ STATUTE EORH E.L. EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYEE $ 1 E.L. DISEASE - POLICY LIMIT 1 $ 1 000,000 C CONTRACTOR'S EQUIPMENT ($10,000 Deductible) MACO247225 7/1/2018 7/1/2019 LEASED/RENTED $250,000 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 I.CR I Iri%,A I G r1ULUCK %,ANl LLLA I IUN 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 REPRESENTATIVE r? Michael Bonetto ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 42864371 1 153241 1 2018-19 Certificate of Liability I Sarah Russell 1 6/26/2018 1:56:49 PM (EDT) I Page 1 of 2 ACOR" AGENCY CUSTOMER ID: 153241 LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED USI Insurance Services and all r e, LLC and all related DBA's 550 Bedford Road POLICY NUMBER Bedford Hills NY 10507 G LO 0381388 CARRIER NAIC CODE Zurich American Insurance Co. 16535 EFFECTIVE DATE: 7/1/2018 ADDITIONAL REMARKS 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: CIS 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 CIS 20 26 (04/13) ADDL INSD-DESIGNATED PERSON/ORGANIZATION CIS 20 37 (04/13) Additional Insured -Owners, Lessees or Contractors -Completed Operations CIS 25 03 (05/09)Designated Construction Project(s) General Aggregate Limit CIS 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 AC:UKU 10 (ZUU8/U1) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ATTACHMENT 42864371 1 153241 1 2018-19 Certificate of Liability I Sarah Russell 1 6/28/2018 1:56:49 PM (EDT) I Page 2 of 2