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Home My WebLink AboutROOF CHECK INC - INSURANCE CERTIFICATEACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID F DATE(MM/DD/YYYY) ROOFC-1 03 04 05 PRODUCER THIS ONLIFICATE IS ISSUED AS A MATTER OF CON CONFERS NO RIGHTS TS UPON HE CERTIFICATE ON 1I D Brown & Brown Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 825 D 1 A S ite P102 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. e aware ve., u Longmont CO 80501 Phone:303-776-3421 Fax:303-776-3219 Roof Check Inc. 1610 SkywayDrive Longmont CO 80504 nnVFRARFA INSURERS AFFORDING COVERAGE NAIC # INSURER A: Mountain States Mutual INSURERB. Pinnacol Assurance INSURER C: INSURER D: INSURER E: 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 NSR - TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION M/ DATE MDD/YY LIMITS A —GENERAL LIABILITY X I COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR XPrProject Aggre CPP007577.504 I. 03/08/05 03/08/06 EACH OCCURRENCE $ 1000000 'REMISES_(17. nccu,nnce) $ 100000 MED EXP (Any one person) $ 10000 PERSONAL &ADV INJURY $1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT LOC PRODUCTS - COMP/OP AGG $ 1000000 Em Ben. 1000000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BAP007577504 03/08/05 III 03/08/06 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ A EXCESS/UMBRELLALIABILITY X OCCUR F-ICLAIMSMADE DEDUCTIBLE X RETENTION $ 10000 UMB007577504 03/06/05 03/06/06 EACH OCCURRENCE $ 5000000 AGGREGATE $ 5000000 $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PROHRIETOR/PAH(NER/EXECUTIVE OFFICER/MEMBER EXCLUDED? It es, describe under SPECIAL PROVISIONS below �3431061 07/r1/14 S TORY LIMITS ER L E4CHACC!DENTB $ 1000000ANY _— E.L. DISEASE - EA EMPLOYEE $1000000 E.L. DISEASE -POLICY LIMIT 1 $1000000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CITYFTC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN City of Fort Collins 281 N . College Ave. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL P O Box 580 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Ft. Collins CO 80522-0580 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Karen Roe - /'e? .-- ewvnv m �a...... ORAPL ZY IJUIHVUMA I IUIV IUSU IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)