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Home My WebLink AboutINDEPENDENT ROOFING - INSURANCE CERTIFICATEAC-ORD" CERTIFICATE OF LIABILITY INSURANCE "AT 016OD/VYYY) ov0slzooe PRODUCER I ASSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 7501 E Lowry Blvd 7501 E o I CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE Denver, CO 80230-7006 COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA PINNACOL ASSURANCE 41190 INDEPENDENT ROOFING INC -- - — -- - 405 22ND STREET INSURLRB GREELEY, CO 80631 I INSURER I au:0 INSURER I' COVERAGES 1 HIPOLICIES OF INSURANCE LISTED BELOW HAVI BELA ISSULU TO THE INSURED NAMED ABOVE FOR THP POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, T ERM OR CONDITION OF ANY CON I RACT OR OTHER DOCOMMENI WITH RESPEC I' 10 WI IICI I THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE. AFFORDED BY II'itE POLICIES DESCRIBED HEREIN IS SUBJECr TO AI_I_ I'I 1E TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LWI IS SHOWN MAY FIAVE BEIFN REDUCED BY PAID CLAIMS. _.. __ ....... �._ _.. wsR ADD( POLICYEFFECTIVE.._� POLICYEXPIRATION GENERAL UAB W IY L AOH oOCLPRI N61 COMMERCIAL GEL L DERAIL r iDAMAGE 90 RLNILD l_ CLAIMS MADE I OCCUR PREMISES _ ML IJ EXP(A Yone..rsan) PERSONAL B AOV INJURY _ GEN'I. AGGREGATE LIMIT APPLIERS PER GENERAL AGGREGATE 1 PRODUCT COMP/OP AGO POLICY J ] PROJECT[.. ) LOC _ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT _i ANY AUTO 1 Ea Accilenl) ALL OWNED AUTOS BODIL Y INJ URY SCHEDULED AUTOS (Per pen ur) HIRED AUTOS i BODILY INJURY NON OWNED AUTOS (Per acntlenl) PROPERTYOAMAGE RAGE LIABILITY nu u UNL r - ANY AUTO OTHER THAN AUTO ONLY'. CE55/UMURCLLA LIABILItt � LACHOCCUI: OCCUR I- ; CLAIMSMADE (AGGREGATE DEDUCTIBLE RETENTION S __ WORKERS COMPENSATION AND Y WC STATU ` iOTHER A iEMPLOYER'S LIABILITY TORY"MRS ANY PROPRIETOIUPARTNEWEXECUTIVE 866470 Ot/O V2009 01/01/2010 E L EACHACCIDENT OFFICELUME:MBER EXCLUDED' - L EL DISEASE EA EMPLOYEE. IfyeS, please deco beundeSPECIpL PROVISIONS below li ^ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER 1124201 City of Fort Collins P.O. Box 580 Fort Collins CO 80522 ACORD CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BF CANCELLED BL=1=012F THE EXTRA rION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO I HE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Charles Doggett Underwriter ACORD CORPORATION 1988 CERTIFICATE HOLDER COPY City of Fort Collins P.O. Box580 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 affordec by the policies listed thereon. ASSURANCE INSURED: INDEPENDENT ROOFING INC 405 22ND STREET GREELEY CO 80631 ENDORSEMENT: Waiver Of Subrogation 7501 E Lowry Blvd Denver, CO 80230-7006 Phone: (303) 361-4000 / (800) 873-7242 Fax: (303) 361-5000 / (888) 329-2251 NCCI #: WC000313 Policy #: 866470 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE City of Fort Collins P.O. Box 580 Fort Collins CO 80522 Effective Date: January 6, 2009 Expires on January 1, 2010 Pinnacol Assurance has issued this endorsement January 6, 2009. Charles Doggett Underwriter Plnnacol Assurance' 7501 F. Lowry Blvd' Denver. CO 80230 Paget of3 PINNAWEB- External/EMP Record Onl 0 1/06/2009 18:31 :41 866470 Updated: 02AM/2007 UW137 No Text CERTIFICATE OF LIABILITY INSURANCE I DATE (01108/00YYY) PINNACOL ASSURANCE 7501 E Lowry Blvd Denver, CO 80230-7006 NSURFI) INDEPENDENT ROOFING INC 40522ND STREET GREELEY, CO 80631 COVERAGES THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE ! COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A. PINNACOL ASSURANCE _INSURERB INSURER INSURER C NAIC# 41190 THEPOLICIESOF INSURANCE IJSII D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, T'IiRM OR CONDI I ION OF ANY CONTRACT OR OTHER DOCUMMENH WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TFII:-_ INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERFIN IS SUBJECT TO ALL. If It, ILRMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,I I_IM1 S SHOWN MAY HAVE BEEN REDUCED 13Y PAID CL AIMS. NGR l AODL Pot ICYIIF1 CTIVf I POIIOYtxPI IGN :RAL LIABILITY MMERCIAL GENERAL LIABILITY CLAIMS MADE I OCCUR GEN I AGGREGATE LIMIT APPI,ICRIS PER ANY AUTO ALI, OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON OWNED AUTOS RAGE LIABILITY ANY AUTO OCCUR I I CLAIMSMADE DEDUCTIBLE ....RETENTION 5....... _.. _.. WORKERS COMPENSATION AND A EMPLOYER'S LIABILITY ANY PROPRIETORIPARTNEILEXCCUTNE 8G6470 OFFICERIAIEMBER EXCLUDED' I( yes, please desc(beundelSPECIAL PROVISIONS below 01/01/2009 1 01/01/2010 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS DAMAGE IO RENT CO PREMISES MEIJ EXP(Anyonepersan) PERSONAL AADV INJURY GENCRA1. AGGREGATE PRODUCTS COMPIOP AGG COMBINED SINGLE LIMIT (Ea Acndenl) BODILY INJURY (Per person) ..._......... BODILYINJURY (Pe cntlent) PROPERTY DAMAGE (Per acndent) AUTO ONLY EA ACCIDENT O TI IER THAN E_AA AUTO ONL Y. A LACHOCCURRENCF AGGREGATE _Y(I WC STATU- _.IOTHER l TORYLIMITS C L EACH ACCIDENT ELDISEASE EAEMPLOYEE CERTIFICATE HOLDER CANCELLATION 1125540 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, 1'HE ISSUING COMPANY WILL ENDEAVOR TO P.O. Box 580 MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Fort Collins CO 80522-0580 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHAIT IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Charles Doggett ACORD 25(2001/08) Underwriter CERTIFICATE HOLDER COPY City of Foil Collins P.O. Box 580 Fort Collins CO 80522-0580 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.