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HomeMy WebLinkAboutCENTRAL STATES ROOFING - INSURANCE CERTIFICATEACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM6/2009YY) 10/26/2009 PRODUCER PINNACOL ASSURANCE 7501 E Lowry Blvd Denver, CO 80230-7006 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 NAIC# INSURED INSURER A: PINNACOL ASSURANCE 41190 CENTRAL STATES ROOFING & INSULATING COMPANY DBA CENTRAL STATES ROOFING DBA CENTRAL STATES ROOFING COMPANY, INC. INSURERS INSURER C: INSURER D: 5925 OMAHA BLVD INSURER E: COLORADO SPRINGS, CO 80915 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PREMISES MED EXP(Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIERS PER: GENERAL AGGREGATE PRODUCTS - COMP/OP AGG POLICY PROJECTn LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea Accident) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Peraccidenl) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC ANY AUTO AUTO ONLY: AG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND X WC STATU- OTHER A EMPLOYER'S LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE - 4090455 O4/O1/2009 04/01/2010 TORY LIMITS E.L EACH ACCIDENT $100,000 E.L DISEASE- EA EMPLOYEE $100,000 OFFICER/MEMBER EXCLUDED? If yes, please describe under SPECIAL PROVISIONS below E.L DISEASE -POLICY LIMIT $SUD DDD OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Re: 7082 Roofing Servies 2009 CERTIFICATE HOLDER CANCELLATION 1191158 City of Fort Collins Purchasing Division 215 N. Mason St., 2nd Floor Fort Collins 80524 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 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 Michelle Madrid-Kneebone ACORD 25(2001108) Underwriter ACORD CORPORATION 1988 CERTIFICATE HOLDER COPY City of Fort Collins Purchasing Division 215 N. Mason St., 2nd Floor Fort Collins CO 80524 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.