2021/10/03 SAFEbuilt Holding CompanyACORD-
COVERAGES
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER: 1706061 s88
9t28t2021
ATTETHCESTIRTEFICASISEUASD oR ORNF TI ONONL DAN ONc EF NRS RIGo SHT U PO TN EH Ec FICARTITE HO ELDR TH ISTICER00TEsENOTFIRMAVELTIoYNRETIVELNEXTEDORALTERETHovEcRAG E F Ro BDED POLtc ESBELOWHtsTEcFRTItcETOFsNURANEcoEsDcoNOfTNSTITEUcNoBTRACTETWEENETHSISGUINNSURERAUTHtzORDE(sESENREPRTTIVEoPRODRcUDNHTEER,HO ERLD
IM RPO ANTT tf certitheficate hold is D TDI o INNAL RSU DE th st h DITADpoicy(i NAtoL UNS ERD rovisi n be ndeporsedUsBRTOGANtotsuctthetoanrmsddnbjnsitionrtaipoltescypoastatemntquhifirtdtenconfeothtstohholcertificatedernlieuofuchndmes
S
312-856,9400 312-856-9425
rnsurance.com
AFFORDING COVERAGE
PROOUCER
RBN lnsurance Services
303 E Wacker Dr Ste 650
Chicago lL 60601
T 9682Hartford Fire lnsurance Co
TNSURER c I Greal American E&S ln
lnsurance Co
s. Co.
29424
37 532
rNsuRER B I Hartford Casual
Fire lnsurance Co 29459INSITRERD: Twin C
I'iISIJR€D
SAFEbuilt Holdinq ComDanv
SAFEbuilt, LLC (See Atiach'edt3755 Precision Drive, Ste '140
Loveland CO 80538
SAFELLC OI
Na
lnsuranc6 Com
rsS lns. Co
12489
36056
INSURER E I Bri
REVISION NUMBER:TNAT
HAVE
TH S TOS RTCE THE OL EStcl o N USRANcE EL VEHA BEEN SS EU TDo THE UNS ED NAMED BOVE FO THE OL CY ER ODNDITEDCAANYTEORlllNcoITDONoONCTTRACoEROTHNIUoocENTHECTESPTOHTHCHSECRTCAI\,4ATE BE Ro TH SURAN NCE EDF-ORD ETH CPOL ES H REE N S ESUBJ Tc TO TLL EN fT SRNlUSEXCLNloANDONcSDTONOFLl.lSUHCPOLESC]iT SS OWNH DEDUCE D [iCLA]S.
PERSONAL & ADV INJURY
GENERAL AGGREGATE s2,000,000X
GEN'L AGGREGATE LIM T APPLIES PER
LOC
OTHER
JECT
X COMMERCIAL GENERAI. LIABILITY
.LA,M.-MADE f o""r"E6
'1ot3t2021 1013t2022 EACH OCCIJRRENCE s 1,000,000
$'1,000,000
$300,000
s 10,000
PROOIJCTS , COMP/OP AGG
S
$2,000,000
L MIT
BOOILY INJURY (Perr6ls)
$ 1,000,000
BOOILY INJURY (Pe. a..ident)
X ANYAUTO
f---_'l owrro
L__.1 auros oNryI v HIREOL1 Auros oNLY
83UENPYg1OOa
X
10t3t2021 1a13t2022AUTOMOBILE LIABILIfY
SCHEDULEO
NON,OWNEO
S
OCCUR
CLAIMS-MAOE
X
X ExcEss LtaB
DED X R€IENTION
cH21EXC885600lC 1013t2021 10t312022 EACN OCCURRENCE
AGGREGATE
95,000,000
$ 5,000,000
XWORKERS COMPENSATION
ANO EMPLOYERS' LIABITITY
ANYPROPRIETORYPARTNER/EXECUTIVE
OFF CER]MEMBEREXCLUOFD'
83WECEO623D
DESC
5t12t2021 5t12t2022
E L EACII ACC DENI
E L OISEASE. POLICY LIM]T
E L. D]SEASE.EA EMPLOYEE
s 1,000,000
$ 1.000,000
$ 1.000c
E Erc@s L'abt2nd)L'ayer TER 2861558
8E-A7-XL-0002079,00 101312022
1at3t2a22 E.ch occrAoli;qais 10,000,000
5,000,000
oEscRrPTtoN oF opEiaTroNs / rocaTtoNs / vEHtc!ERE FY2O2OI21 BUILDING & SAFETY PLAN
S (ACORD iot. Additionrl R.m.rt. Sch.dut., m.y b. !i.ch.d f more +!{ i. oqun d)REVIEW SERVICES
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIAED POLICIES BE CANCELLED AEFORETHE EXPIRATIOiI OATE TXEREOF, NOTICE WLL EC OCLIVCNEO INACCOROANCE wlTH THE POLICY PROVISIONS.City of Menifee
29844 Haun Road
Menifee CA 92586 AI,]THORIZED REPRESENTATIVE
ACORO 25 (2016/03)
o 1988-2015 ACORO C
The ACORD name and logo are registered marks ofACORD
ORPORATION. All rights reserved.
AM END,THE
CERTIFICATE
tf WAIVED,endorsement.the
REOUIREI\,4ENT.
LISTEDNOTWITHSTANOING ANYISSUEDPERTAIN.DESCRIBED
BEEN
83UENZV3S51
S
s
s
1013t2021
1013t2021
city of l\'Ientfee and ils officers emDlovees. agenls. and author;zed volunteers are addrtional rnsLred on a primary and non-conhbutory basis as respects theGenerat Liabrtirv as required bv wriilei conka;t. so oav notici oiEniL]i"iio'n'g;Jn-io tne ""rrrrcare horder.