HomeMy WebLinkAboutCENTRAL STATES ROOFING COMPANY INC - INSURANCE CERTIFICATE (2)ACORD M CERTIFICATE OF LIABILITY INSURANCE
DATE(MM,D2/
D13D,ZD11„
PRODUCER
PINNAC ASSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Den E Lowry Blvd
Denver, CO 80230-7006
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
CENTRAL STATES ROOFING & INSULATING COMPANY DBA CENTRAL
BJSURERA: PINNACOL ASSURANCE
41190
INSURER B:
STATES ROOFING
INSURER L:
DBA CENTRAL STATES ROOFING COMPANY, INC.
5925 OMAHA BLVD
COLORADO SPRINGS, CO 80915
INSURER D:
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 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
POLICYEFFECTIVE
POLICYEXPIRATION
LTR
INSRO
TYPE OF INSURANCE
POUCYNUMBER
DATE(MWDDn'YYY
DATE(MWDDM'YY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
DAMAGE TO RENTED
COMMERCIAL GENERAL LABILITY
CLAIMS MADE OCCUR
PREMISES
MEDEX An o
PERSONAL B ADV INJURY
GEN'L AGGREGATE LIMIT APPLIERS PER:
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGO
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AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
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ALL OWNED AUTOS
SCHEDULEDAUTOS
(Per person)
BODILY INJURY
HIRED AUTOS
NON OWNED AUTOS
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(Per midenl)
GARAGE LIABILITY
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AUTO ONLY: AG
EXCESWUMBRELLA UUBILITY
EACH OCCURRENCE
AGGREGATE
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
WC STATU- Ll OTHER
A
EMPLOYER'S LIABILITY
ANY PROPRIETORIPMTNERIEI(ECUTIVE
4090455
04/01/2011
04/01/2012
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ELDISEASE- POLICY LIMIT
$00000
OTHER
DESCRIPTION OF OPERATIONS/LOCATONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Re: Roofing Project at EPIC and Senior Center, Bid No 6126
CERTIFICATE HOLDER
CANCELLATION
1300488
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fart Collins Purchasing Division
THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
215 N Mason St 2nd Floor
MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Fort Collins CO 80522
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(2001/08)
Underwriter ACORD CORPORATION 1988
Pinnacol Assurance' 7501 E Lowry Blvd
Page 1 of 3
PINNAA COL
ASSURANCE
7501 E Lowry Blvd
Denver, CO 80230-7006
Phone: (303) 361-4000 / (800) 873-7242
Fax: (303) 361-5000 / (888) 329-2251
www.ornacol.conn
NCCI #: WC000313
Policy #: 4090455
INSURED: AGENT:
CENTRAL STATES ROOFING & INSULATING C HUB INT INS SERVICES INC/PUEBLO
DBA CENTRAL STATES ROOFING COMPANY, I PO BOX 58
5925 OMAHA BLVD PUEBLO, CO 81002
COLORADO SPRINGS CO 80915 (719) 544-2533
ENDORSEMENT: Waiver Of Subrogation
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 Purchasing Division
215 N Mason St 2nd Floor
Fort Collins CO 80522
Effective Date: March 30, 2011 Expires on April 1, 2012
Pinnacol Assurance has issued this endorsement March 30, 2011.
Michelle Madrid-Kneebone
Underwriter
Denver, CO 80230
PINNA WEB- External I EMP Record Opt
03/30/201118:40:53 4090455 Updated: 02/01/2007
UW137