HomeMy WebLinkAboutD & D ROOFING INC - INSURANCE CERTIFICATE (2)PSEfiI bau
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S A OC RH CERTIFICATE OF LIABILITY INSURANCE DATE03/2 %12
10/03/2012
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(les) 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 1-303-534-e567 CONTACT
INA, Inc. - Colorado Division NAME:
PHONE FAX
WC, No. Exll:___-
1550 17th Street E-MAIL den em0imeco com
ADDRESS: D rp• _
Suite 600 -- —
Denver, CO 80202 __ _—__ --- iNSURER(S)AFFORDINGCOVERAGE r NAICO
CONTINENTAL WESTERN INS CO
—
INSURER C___---
6270 B. 50th Ave. INSURER D_
Commerce City, CO 80022 INSURERE____
INSURER F:
COVERAGES CERTIFICATE NUMBER: 29481189 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.
Ilffi� TYPE OF INSURANCE AWISH DOL EXP
WYO POLICY NUMBEfl I MMMOPDLIC` YYYEFF� MMKo-POLIC`YYYY F LIMITS
A
GENERAL LIABILITY
LVP256346730
10/01/13
10/01/13
EACHOCCURRENCE
$ 1,000,000
g COMMERCIAL GENERAL LIABILITY
_ r lI
-CLAIMS-MADE I X I OCCUR
__
DAMAGE TO RENTED
PREMISES (Ea a¢urterce)_
EX_P An, area persona
300 r 000
f __—_
$ 10,000
Y PD: $10,000
_MED
PERSONAL It ,DV INJURY
$ 1,000,000
_
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS-COMPIOP AGG
f2,000,000
GEN'LAGGREGAA LIMIT APPLIES PER:
POLICY I " PRO LOC
S
IL
AUTOMOBILE
LIABILITY
CWP256346730
1 1
COMBINED SINGLE LIMIT
(Ea a«iEenO_.___ _ _;____
1,000,000
$
%
ANY AUTO
BODILY INJURY (Par persona
—
-LOWNED SCHEDULED
AUTOS AUTOS
_.
BODILY INJURY (Per accident)
E
Y
HIRED AUTOS % UTSWNED
AO
(Paad.DAMAGE
ar ct)$
_
f
A
%
UMBRELLA LIAR
%
OCCUR
CU3003706
10/01/1
10/01/13
EACHOCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
EXCESS LAB_
CLAIMS -MADE
_
OEO % I RETENTION$O
$
WORKERS COMPENSATION
WCSTATU- I
ANDEMPLOYERS'LIABILITY YIN
ANY PROPRIETOR ARTNEREXECUTIVE
OFFICE"EMBER EXCLUDED?
NIA
TORYLIMITS
S
_ �IOER-
E.L.EACH ACCIDENT
— -----
E.L. DISEASE - EA EMPLOYEE
$
(ibmalmoryNNNa
j.SCRJPT1ON OF OPERATIONS below
EL. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKsch ACORD 101, Additional Rsmerhs Schedule, If more space M reduind)
City of Fort Collins is included as Additional Insured on the General Liability Policy if required by Written contract
or agreement and With respect to Work performed by Insured subject to the policy terms and conditions.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
of Port Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
215 North Meson Street,
AUTHORIZED REPRESENTATNE / ///�'^/��/(/
Fort Collins, CO 00522 f //,�if
USA
All rinhfc •uen,vnd
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
meescoe
29481189
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