HomeMy WebLinkAboutD & D ROOFING INC - INSURANCE CERTIFICATE``l �® CERTIFICATE OF LIABILITY INSURANCE
9;5; 012YYY)
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 Erica Faulhaber, CIC, CISR
NAME:
Fa No:'(303)370-0118
PHONE (303)824-6600 1
E-MAIL . efaulhaber@moodyins. coal
INSURERS AFFORDING COVERAGE
NAICe
INSURER A:Pinnacol Assurance
41190
INSURED
D & D Roofing, Inc.
6270 East 50th Avenue
Coamlerce City CO 80022
INSURER B :
INSURER C:
INSURER : D
'SURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:12-13 Work Comp REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEDBELOW 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
LTfl
TYPE OF INSURANCE
ADDLSUBR
POLICY NUMBER
POLICY EFY
POLICY EYP
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
-
-
EACH OCCURRENCE
$
DAMAGE To RENTED
PREMISE Ea currence
$
MED EXP (Any one person)
$
PERSONAL &ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE
POLICY
LIMIT APPLIES PER:
PRO -LOG
PRODUCTS - COMP/OP AGO
$ -
$
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
(PC, nt
$
$
UMBRELLA LIAR
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED I I RETENTION
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
PROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
048526
10/1/2012
0/1/2013
X WC STATUS OTH-
CRY 'WTANY
E.L. EACH ACCIDENT
$ 11000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
E.L.DISEASE -POLICY LIMIT 1
$ 1.000.000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Atldtional Remarks Schedule, 0 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.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010/05)
INS025 (201006).01
Faulhaber, CIC, CIS
O 1988-2010 ACORD CORPORATION. All rights reserved.
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