HomeMy WebLinkAboutROOF CHECK - INSURANCE CERTIFICATEacoRv CERTIFICATE OF LIABILITY INSURANCE OP ID T3 DATE (MMIDDIYY)
OFC-1 06/17/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Brown & Brown Inc - Longmont HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
825 Delaware, Suite P-102 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Longmont CO 80501
Phone: 303-776-3421 INSURERS AFFORDING COVERAGE
Roof Check Inc.
1610 SkVway Drive
ID 8054
Longmont 0
V V V CKAUIEb
wsURERA: MOUNTAIN STATES MUTUAL
INSURERB: Pinnacol Assurance
INSURER C:
INSURER D:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
ILT
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE MMIDDIYV
POLICY EXPIRATION
DATE IMMIDDIYYI
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [*] OCCUR
X Jobsite Pollution
CPP7577502
03/08/03
03/08/04
EACH OCCURRENCE
$ 1 , OOO , OOO
FIRE DAMAGE (Any one fire)
$50,000
MED EXP (Anyone person)
$ 10 , 000
PERSONAL& ADV INJURY
$ 1 , 000 , 000
GENERAL AGGREGATE
s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
17 POLICY X , PRCJEC LOC
PRODUCTS - COMP/OP AGG
s2,000,000
Pollution
100,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULEDAUTOS
HIRED AUTOS
NON -OWNED AUTOS
BAP7577502
03/08/03
03/08/04
COMBINED SINGLE LIMIT
(Ea accident)
$ 1 000 000
r
X
X
BODILY INJURY
(Per person)
$
X
X
BODILY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
$
EA OTHER THAN ACC
AUTO ONLY: AGG
$
$
A
EXCESS LIABILITY
X I OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
UMB7577501
03/08/03
03/08/04
EACH OCCURRENCE
$ 5000000
AGGREGATE
$ 5000000
$
B
WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY
I
3431061
07/01/03
07/01/04
X TORY LIMITS ER
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
$ 500 , 000
E.L. DISEASE -POLICY LIMIT
$500,000
OTHER
F
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES,EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CITYFTC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -I-Q-- DAYS WRITTEN
City of Fort Collins NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
281 N . College P O Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Ft. Collins CO 80522 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
TInN 19RR