HomeMy WebLinkAbout262877 RTN ROOFING SYSTEMS - INSURANCE CERTIFICATEOP ID: KE
CERTIFICATE OF LIABILITY INSURANCE
DA 07/0 DIYYYY)
07I07111
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. -
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). -- -
PRODUCER -- 970-223-1804
Front Range Insurance Group
1100 Haxton Drive Suite 100
Fort Collins, CO 80525
Steven G. Smith
CONTACT - -- — - - -
NAMEPHONE
FAX -
JAIC, No Eat): '(AIC, NO):
E—MAIL
-ADDRESS:
PRODUCER RTNRO-1
CUSTOMER to #,
INSURER(S) AFFORDING COVERAGE
NAIC is
INSURED RTN Roofing LLC
INSURER A: Continental Western
Jeff Lozon
6854 Lockheed Ave.
Loveland, CO 80538
INSURER B : First Mercury Insurance
-_
INSURER C : Pinnacol Assurance
41190
INSURER D:
INSURER E:
INSURER I:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL30
POLICY NUMBER
POLICY EFF
MM/pDADOD
POLICY E%P
MWDDIYYYY
LIMITS
B
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE 7X OCCUR
FMMA003984
'-
-
09/29/10
09/29/11
EACH OCCURRENCE
S 1,000,00
PREMISES Eaoourrenca)
S 50,00
NED EXP(Any one )ersao)
$
PERSONAL R.".DVIUPJR_Y_
S 1,000,00
5 2,000,0010
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER.
X POLICY F7 PRO F7 LOC
PRODUCTS-COMPIOPAGG
$ 2,000,00
$
A
AUTOMOBILE
LIABILITY -
ANYADTO
ALLOWNED AUTOSBODILY
AUTOS
HIRED AUTOS
NON -OWNEDAUTOS
CA268977922
05/01111
05101/12
COMBINED SING! !:LIMN
(Ea acddenq
S 1,000,00
BODILY INJURY(P-I Prmn)
$
JX
INJUGSCHEDULED
PROPERTY YVi',CE
(Par accident
5
X
S
5
UMBRELLA MAE
EXCESSLIAe
OCCUR
CLAIMS -MADE
EACH OCCURItL IICE
5
$
AGGREGATE.______
DEDUCTIBLE
RETENTION $
5
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE YIN
OFFICERIMEMBER EXCLUDED? ❑
(MandatoryinNH)
If yes, describe under
DESCRIPTIONOFOPERATIONSbelow
NIA
4143260
10/12/10
10/12/11
�. WC SI?.I
TORY LI I:1, IS i _ j Elt_
ELEACHACCICE'L $ 100,00
-
EL. DISEASE- EA EMPLOYEE 5 100,000
--
EL.DISEASE -PO. 1" IIMIT i 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks SGbcdule, If more space Is required)
City of Fort Collins
700 Wood St
Fort Collins, CO 80521
CITY OF
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE :':4L BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2009/09)
ra
The ACORD name and logo are registered marks of ACORD
IOtL All riahis reserved