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Home My WebLink About453145 INDEPENDENT ROOFING INC - INSURANCE CERTIFICATE (3)ACORD.. CERTIFICATE OF LIABILITY INSURANCE °ATE(MM01/02/2013212013 Y) 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# l INSURED Independent Roofing Inc 405 22nd Street Greeley, CO 80631 INSURERA: Plnnacol Assurance 41190 INSURER B: '. INSURER CURER INS 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 DATE(MWDD/YYYV) DATE(MM/DD/YYVY) LIMITS GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR PREMISES MED EXP(Any one person) PERSONAL 8 ADV INJURY GEN L AGGREGATE LIMIT APPLIERS PER GENERALAGGREGATE PRODUCTS-COMP/OPAGG POLICY 11 PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ., ANY AUTO (Es Accident) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY HIRED AUTOS NONlOWNEDAUTOS (Per accident) PROPERTYDAMAGE (Per ecddem) GARAGE LIABILITY AUTOONLV-EAACCIDENT OTHER THAN EAACC ANYAUTO } 1 AUTO ONLY AG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE OCCUR CLAIMSMAOE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION ANO WC STATU- OTHER A EMPLOYER'S LIABILITY ANY PROPRIETOP/PARTNEWEXECUTIVE 866470 01/01/2013 01/01/2014 TORY LIMITS E.L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED' E.L DISEASE - EA EMPLOYEE $1,000,000 If yes, pleasetlesrnbe under SPECIAL PROVISIONS below ELDISEASE-POLICY LIMIT 1000 Q00 OTHER - DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1426186 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fart Collins PO Box 580 THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 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(2001I08) Underwriter ACORD CORPORATION 1988 PINNd1COL 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 2, 2013 Expires on January 1, 2014 Pinnacol Assurance has issued this endorsement January 2, 2013. Charles Doggett Underwriter Pianacol Assurance' 7501 E Lowry Blvd * Denver, CO 80230 Page 1 of 3 PINNAWEB- 01/02/201319:51:58 866470 Update :0210112007 UW137