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Home My WebLink About453145 INDEPENDENT ROOFING INC - INSURANCE CERTIFICATE (2)ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ovc4rzolz PRODUCER Pinnacol Assurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 7501 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 `'� Independent Roofing Inc�t �> 405 22nd Street INSURERA: Pinnace[ Assurance 41190 INSURER B'. INSURER C: Greeley, CO 80631 INSURER D- INSURER E: 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 DATEIMMIDD/YYYY) DATE(MM/DDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PREMISES MED EXP(Any one person PERSONAL B ADV INJURY GENL AGGREGATE LIMIT APPIIELIERS PER: GENERAL AGGREGATE PRODUCTS � CONFIDE AGO POLICY1:1 PROJECTI LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO Ca Accoenl BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILYINJURY HIREDAIROS NON -OWNED AUTOS (Per accdenl) PROPERTY DAMAGE (Pereccbeni) GARAGE LIABILITY AUTO ONLY EA ACCIDENT OTHER THAN EA ACC ANY AUTO AUTO ONLY. AG E%CESSIUMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND WC STAN- OTHER A EMPLOYER'S LIABILITY ANY PROPRIETOR/PARTNEWE%ELUTIVE 866470 01r01/2012 01r01/2013 TORV LIMITS El FACM ACCIDENT $1,000.000 OFFICERIMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $1,000.000 It yes.pleesedescnCeuMer SPECIAL PROVISIONS elow E L DISEASE -POLICY LIMIT $1,00,000 OTXEP DESCRIPTION OF OPERATIONSILOCATIONSIVEHIC LESIEXCLUSIONS ADDED BY ENDORSEME NTISPECIA L PROVISIONS CERTIFICATE HOLDER CANCELLATION 1355480 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Collins THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO P.O. Box 580 MAIL 10 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 Charles Doggett ACORD 25(2001108) Underwriter ACORD CORPORATION 1988 PINNAA COL ASSURANCE INSURED: Independent Roofing Inc 405 22nd Street Greeley, CO 80631 ENDORSEMENT: Waiver Of Subrogation 7501 E Lowry Blvd Denver, CO 80230-7006 Phone: (303) 361-4000 / (800) 873-7242 Fax: (303) 361-5000 / (888) 329-2251 NCCI #: WC000313 Policy #: 866470 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 P.O. Box 580 Fort Collins. CO 80522 Effective Date: January 4, 2012 Expires on January 1, 2013 Pinnacol Assurance has issued this endorsement January 4, 2012. Charles Doggett Underwriter Ponacol Assurance' 7501 E Lowry Blvd 4 Denver, CO 80230 Page 1 of PINNAWEB- External/EMP Record Onl 01/041201218',49:18 866470 Updated: 02/01/2007 UW137 ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE (MMYY) lzo,z DvO412012 PRODUCER Pinnacol Assurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 7501 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 Independent Roofing Inc 405 22nd Street INSURERA: Pinnacol Assurance 41190 wsuRERB: INSURER Greeley, CO 80631 INSURER D. INSURER E'. 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 POLICY EFFECTIVE POLICYEXPIRATION LTR INSRO TYPE OF INSURANCE POLICYNUMBER OATE(MWDD/YYYY) DATE(MWDD/YTYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY CLAIMSMAOE OCCUR PREMISES MEDEXP(An oneper n) PERSONAL B ADV INJURY GEN'L AGGREGATE LIMIT APPLIERS PER GENERALAGGREGATE PRODUCTS COMPIOPAGG POLICY PROJECT LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea AWfIe ) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Pere .r ) BOOILYINJURY HIREDAUTOS NON -OWNED AUTOS IRA, a...0 PROPERTYOAMAGE GARAGE LIABILITY AUTOONLY EA ACCIDENT OTHER THAN EA ACC ANTAIITO AUTO ONLY: AG EXCESSAJMBRELLA LIABILITY EACHCCCURRENCE AGGREGATE OCCUR El CLAIMS MADE DEDUCTIBLE RETENTION E WORKERS COMPENSATION AND WCSTATU- OTHER A EMPLOYER'S LIABILITY ANY PROPRIETOR?ARTNERIEXECUTIVE 866470 01/01/2012 01/01/2013 TORY LIMITS EL EACH ACCIDENT $1,000.000 OFFICERMEMBER EXCLUDED? ELDISEASE-EAEMPLOYEE $1,000,000 II yes, please OesalUeunJarSPECIAL PROVISIONS Lebw ELDISEASE- POLICTLIMIT $, 000000 OTHER DESCRIPTION OF OPERATONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1355449 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City 01 Fort Collins THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO PO Box 580 MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Fort Collins, CO 80522-0580 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 Charles Doggett ACORD 25(2001/08) Underwriter ACORD CORPORATION 1988