HomeMy WebLinkAboutBOULDER ROOFING - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE OP ID MS
BOULD-2 07/01/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Forsberg Engerman Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3575 S. Sherman St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Englewood CO 80113
Phone: 303-762-1717 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: employers Mutual casualty co
INSURER B:
Boulder Roofing, Inc. Am yy Hawkins INSURER C:
3551 Pearl Street INSURERD:
Boulder CO 80301
INSURER E:
COVERAGES
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
DATE (MMIDDIYY)
DATE (MMIDDIYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1000000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 1XI OCCUR
3D0883510
07/01/09
07/01/10
PREMISES (Ea occurence)
$ 100000
MED EXP (Any one person)
$ 5000
PERSONAL & ADV INJURY
$ 1000000
GENERAL AGGREGATE
$ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2 0 0 0 0 0 0
X POLICY PEa LOC
AUTOMOBILE
LIABILITY
A
ANY AUTO
3DO883510
07/01/09
07/01/10
COMBINED SINGLE LIMIT
(Ea accident)
$ 1000000
X
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
HIRED AUTOS
X
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
X
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
$
AUTO ONLY: AGG
$
EXCESS/UMBRELLA LIABILITY
OCCUR ❑ CLAIMS MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
TORY LIMITS ER
E.L. EACH ACCIDENT
$
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
SPECIAL PROVISIONS below
OTHER
A
Scheduled Equipmen
3CO883510 ($1000 om)
07/01/09
07/01/10
$12000 Limit
A
Leased/Rented Equi
3CO883510 ($1000 0®)
07/01/09
07/01/10
$25000 Limit
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
CITYFOR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Fort Collins IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
PO BOX 580 REPRESENTATIVES.
Ft Collins CO 80500 AUT IZEDREPRESENTATIV
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