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HomeMy WebLinkAboutBOULDER ROOFING - INSURANCE CERTIFICATE (2)ACORD. DATE/20I09 CERTIFICATE OF LIABILITY INSURANCE 2/24/2009 PRODUCER (303) 824-6600 FAX: (303) 370-0118 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moody Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 3773 Cherry Creek North Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 800 Denver CO 80209-3804 INSURERS AFFORDING COVERAGE NAIC # INSURED wsURERA:Pinnacol Assurance 41190 Boulder Roofing, Inc. INSURER B: 3551 Pearl Street Boulder CO 80301 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. AGGRE ATE LIMITS SHOWN MAY HAVE BEEN EDUCED BY PAID S. INSR ADDT TYPE OFINSURANGE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY POLICY EXPIRATION DATE MMIODNY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ed occurrence $ COMMERCIAL GENERAL LIABILITY MED EXP Any one percent $ CLAIMS MADE 0 OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO $ PRO- POLICV JECT LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per Person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY co (Per aidem) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANYAUTO $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X TORY LAMIT EH E.L. EACH ACCIDENT $ 100,000 ANY PROPRIETORIPARTNEWEXECUTIVE E.L. DISEASE EA EMPLOYEE$ 100,000 OFFICER/MEMBER EXCLUDED? If yes, descirbeunder 2058510 4/l/2009 4/1/2010 E.L. DISEASE POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDOR$EMENTISPECIAL PROVISIONS This certificate is subject to the terms, conditions, and exclusions of the policies. A 10-day notice of cancellatio will apply in the event of non-payment of premium. City of Fort Collins P.O. Box 580 Fort Collins, CO 80500 ACORD 25 (2001/08) IMCn49,m no.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Erin Threlkeld, © ACORD CORPORATION 1988 oene I n! 9 FiTZOORTEMID 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 (2001108) INS025 toi oel.oaa Page 2 or 2