HomeMy WebLinkAboutD&D ROOFING INC - INSURANCE CERTIFICATE (3)Ali �® CERTIFICATE OF LIABILITY INSURANCE
9/28/2011
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 endorsements .
PRODUCER
Moody Insurance Agency, Inc.
8055 East Tufts Avenue
Suite 1000
Denver CO 80237
CONTACT Erin Threlkeld, CRIS
NAME:
PHONE (303)824-6600 FA% (303)310-0118
E-MAIL , ethrelkeld®moodyins.com
INSURERS AFFORDING COVERAGE
NAICs
INSURER A:Pinnacol Assurance
1190
INSURED
D & D Roofing, Inc.
6270 East 50th Avenue
Cornmerce CityCO 80022
INSURER a
I INSURER C:
INSURER D:
NSUR2 E :
INSURERI
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.
INSfl
LTR
TYPE OF INSURANCE
ADDLSUBR
POLICY NUMBER
POLICY EFF
M DNYYN`I
POLICY EXP
(MNVDD1YYYYI
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
-
EACH OCCURRENCE
$
AMA N
PREMISES Ea occurrence
$
MED EXP (Any oneperson)
$
PERSONAL B ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE
POLICY
LIMIT APPLIESPER:
•JECTPRO LOC
PRODUCTS-COMP/OP AGG
$
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
-.
COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per citl n
$
$
UMBRELLA LIAR
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION
$
AWORKERS
COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETORIPARTNEWEXECUTIVE N
OFFICER/MEMBER E%CLUOED?
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
04e526
0/1/2011
0/1/2012
X WC STATU OTH
E.L. EACH ACCIDENT
$ 50O 000
E.L. DISEASE -EA EMPLOYEE
$ 500,000
EL. DISEASE -POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (Attach ACORD 101, Add Kional Remarks Schedule, B more space is required)
City of Fort Collins
215 North Mason Street
2nd Floor, PO Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25
Threlkeld, CRIS/CHR
O 1988-2010 ACORD CORPORATION. All rights reserved.
INS025 (20100$).01 The ACORD name and logo are registered marks of ACORD