HomeMy WebLinkAboutACC ROOFING - INSURANCE CERTIFICATE (9)/ACORD°, CERTIFICATE OF
LIABILITY INSURANCE oAr( °210812'ouYY'
PRODUCFR
PINNACOL ASSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
7501 E Lowry Blvd
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Denver, CO 80230-7006
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
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-INSURLD ... _.... .... ..._ _.....
INSURERA ..._. PINNACOL ASSURANCE 41100
ACC ROOFING INC
--- ---- ---- --- --- --- --
1713 E. LINCOLN AVE
INSURERS
-
UNIT B3
IlusuRERc
FORT COLLINS, C080524
INSURERD
-.. _.._ -.. __..
NSURER E
---.. _._... _..-. _..-. _.... -.... _
COVERAGES..__..
THE POLICIES OFINSURANCELISTED BELOW HAVE. BEEN ISSUI 1) 10 1I1 INSUI21:1)
NAMI D A130VE I OR III] POLICY PERIOD INDICATED. NO [Will ISTANDNG
ANY REQUIRI MEN 1, TERM OR CONDITION OF ANY CONTRACT OR 01111-R DOCL/MMIiN
T WrrH RESPECT TO WHICH THIS CERTIFICATE MAY 131E ISSUI"1) OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DI-SCRI13ED HEREIN IS SUBJECT TO ALE. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POI.ICIL S. LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSIi ADOI I
POLICY EFFECTIVE ' POLICY EXPIRATION
IIR INSRO TYPE OF INSURANCE _ POLICYNUMBER
HAT EIMMIDD/YYYY) DATELAMIDDNYYY) _ LIMITS
GENERAL LIABILITY
F ASH OCCURRENCE
COMIAERCIAL GENERAL IABILnY
DAMAGE I O RENTED
LEM MADE OCCUR I
PREMISES
MEWL AGGREGATE LIMIT APPLORS PER
IOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON OWNED AUTOS
SAGE LIABILITY
ANYAUTO
OCCUR 1 1 CLAIMS MADE
DEDUCTIBI E
WORKERS COMPENSATION AND
A EMPLOYER'S LIABILITY
ANY PROPRIETORIPARTNERJEXECUTIVE
I OFFICEWMEMBER EXCLUDEDP
I(yos, plAuse JescdpauntlarSPEOIAL PROVISIONS balm
4081645
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXOLUSIONS ADDED BY
CERTIFICATE HOLDER
THE CITY OF FORT COLLINS
PURCHASING DIVISION
215 NORTH MASON ST.
P O BOX 580
FORT COLLINS CO 80522
ACORD
PRODUCTS COMPIOP AGO
COMBINED SINGLE DEAD
(La Accident)
FOUR Y INJURY
(Pc" on)
s
BODILY INJURY
(Pm aAodBbl)
PROPERTY DAMAGE
(Par acadaOU
AUTO ONLY EA ACCIDENT
OTHER THAN EA
AUTO ONLY. P
��- EACHOCCURRENCE
AGGREGATE
1 l
WC STATU 1OTHER
06/01/2008 06/01/2009 TORYIIMnS
r L UACH ACCIDENT
PLL DISEASE EA EMPLOYEE
PROVISIONS
CANCELLATION
THE EXPIRAI ION DAZE. THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL. 0 DAYS WRITTEN NONCE TO THE CERTIFICATE HOLDER NAMED TO THE
FEE 1, BUT FAILLIRI- TO MAIL. SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON LIFE COMPANY, ITS AGENTS OR
RI PRI.--: SENTATI VE S.
Charles Doggett
CERTIFICATE HOLDER COPY
THE CITY OF FORT COLLINS
PURCHASING DIVISION
215 NORTH MASON ST.
P O BOX 580
FORT COLLINS CO 80522
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.