HomeMy WebLinkAboutBOULDER ROOFING INC - INSURANCE CERTIFICATE 2020-2021A� O� CERTIFICATE OF LIABILITY INSURANCE oarE�Mhuoomv�ry
0311 7120 2 0
THIS CERTIFlCAT� IS 15SUED A5 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CEiiTIFICATE DOES NOT AFFIiiMATIVELY pii NEGATIVELY AlJ1END, EXTENd OR ALTER TME COVERAGE AFFORDED BY 7HE PDLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CaNS71TUTE A CONTRACT BE'f1NEEN THE [SSUlNG INSURER{S], AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICA'iE HOLDER.
I�VIPORTANT: If the certificate holder is an ADDITIONAL INSUR�p, the pollcy(les) must ha�e ADDITiONAL INSURED provisfons or be endorsed.
If SUBROGATION IS WAIVED, subJect to the terms and canditions o( the policy, certain policies may requlre an endorsemenf. A statement on
this certificate does not confer rights to the certiticate holder in lieu of such endorsement(sj.
PROaUCER coNracr MoodylnsuranceAgency, Inc.
NAME:
Moody Insurance Agency, Inc. Pvc Na Ex� : i303j 824-6600 �� No :(3D3) 370-0118
8055 Easl7uftsAvenue E'M'�� certrequestQmoodyins.com
AODRE55:
5uite 1000 INSIIRER(S� AFFOROING COYERAGE NAIC #
Denver CO 80237 ir�suRER A: Pinnacol Assurance 41190
INSURED INSURER B :
Baulder Roofing, If7C. INSUR@R C:
3551 Pearl Si INSURER U:
Boulder C4 8D301 INSURER F:
COVERAGES C�RTIFICATE NUlJIBER: 20-21 Masier REVI510N iJUMB�R:
THIS IS TO CERTIFY TFIAT THE POE.IGIES OF INSURANCE L15TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOp
INDICA7ED. NQ71M7HSTANDINGANY REQUIREMENT, TERM OR CdNDIT10N OF ANY CONTRACT Oft OTH@R pOCUMENT 1MTH RESPEC7 YO WHICH THIS
CEftTIFICATE MAY BE ISSUED OR MAY PERTAIN, TFiE INSURANCE AFFORDED BY TH� POLICIES �ESCRIBED HEREIN IS SUBJECT TO ALL TFiE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE SEEN REOUCED BY PAI� CLAiMS.
LTR 7YPE OF INSURANCE INSD WYD POLICY NUMBER MM DDNYYY MMlOUlYYYY LIMITS
COMMERGIAI. GENERA4 LtA91LITY EAGH OCCURRENCE S
A A
CLAIMS-MADE OCCUR PREMISES Ea occunence S
GEN'L AGGREGATE LIM{T APPLIES PER
� POLICY PRO-
JEGT L�
OTHER:
AU70M081LE LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
NIRED NONANMED
AUTOS ONIY AUiOS ONLY
UMBRELLA LIAB p�CUR
EXCE55 LIAB CLAIMS-MADE
�ED RETENTION 5
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y! N
ANY PROPRIETORlPARTNERlExECUTIVE
'�' OFFICERlMEMBEREXClUDEO? ❑ N!A 2058510
PERSONAL 8 A�V INJURY
GEMERALAGGREGATE
BOOILY INJURY [Per personj
BOOILY INJURY (Per accident)
EACH
0414 1 12 0 2 0 � D41b1l2021 EL EACHACCIDEIVT
F i nICC6CK . Fn FAA
L DISEASE •
DESCRIpTION OF OP@RATIONS ! LOCATIONS ! VEi11CLE5 (ACORU 101, Addllional Remarks Schedule, rnay be attached II more space Is requfrsdj
CANCELLATION
City of Forl Collins
PO Box 580
co sosoo
S
5
5
S
S
S
5
5 10D,000
5 100,000
� sao.oao
SHOULD ANY OF THE ABOVE ti�SCRIBED POL1ClES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE UELIVERED IN
ACCORUANCE WITH THE POLICY PROVISIONS.
' � ��
Fart Colli�rs
AUTHORIZHO REPRESENTATIVE
O 1988-2415 ACORD CORPORATION. All rights reserv�
ACORD 25 (2016103) The ACORD name and logo are reg9stered marks of ACORD
ACO OR �
��
AGENCY
MooBy lnsurance Agency, lnc.
POLICY NUM6ER
CARRIER
GI 11tfL�1 `.L•I�:� �lflGl;T:f-'i
AGENCY CUSTOMER ID:
LOC #:
ADDITIONAL REMARKS SCHEDULE
NAME�INSUREO
8oulder RooFng, fnt
NAIC COUE
EFFECTIVE bATE:
Page of
7HIS ADDITIONAt REMARKS FORM 15 A SCHEUULE TO ACORD FORM,
FORM NU�4IBER: 25 FORM TITLE: Cenificale oi Liabilily Insurance: Notes
CONTRACTUAL LIABILITY APPLIES PER POLICY TERMS AND CONDITIONS
Worker's Compensaiion:
359-B From Attached Includes Blanket Waiver of Subrogalion. Status applies when required by writlen contracl
IMPORTANT
The policy forms referenced wilf be sent via emaii only. To obtain copies, please send your request wilh Ihe ema;l address to certrequest@moodyins.com.
� 2008 ACORD CORPORATEON. All rights reserved.
The ACOR� name and logo are registered marks of ACORD