The URL can be used to link to this page

Home My WebLink About453145 INDEPENDENT ROOFING INC - INSURANCE CERTIFICATE (4)CERTIFICATE OF LIABILITY INSURANCE DATE0M,I 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 NAICA _ INSURED /l E� 'dependent Roofing Inc Ar 1 405 22nd Street i1 INBURERA Pinnacol Assurance 41180 INSURER B: INSURERO: 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR ADDL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPEa WIBUWCE POLICYNUMBER DATEWWDIYYYY DA MWODIYYYY UNITS WNBRAL LIABILITY EACH OCCURRENCE ONAAOE TO RENTED CONMERCLLL GENERN LIABILITY CLAIMSMADE OCCUR PREMISES LEO M R PER3 &ADVWURY GEN%AGGREGATE LWITMK1ERS PER: ON ENERAGGREWTE PRODUCTS -COMPIOP AGG 17 POLICY F PROJECT LOC AUTOMOBILE LABILITY COM MO SPABE LIMIT ANY AUTO IFjA {perE BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS Per roan BODILY INJURY HIRED AUTOS NONOWNEDAUTOB jftr.m enl RROPBRTY DAMAGE eMAOE LMBll11' AUTO asr-EA ACCIOFM I ANYAUTO OTIER TIMN "ADD AUTOON.Y - BXDEBSNYBRELLALMNLRY OCCUR F I CWMS MADE EACN OfLIIA•@NCB DEDUCTIBUF _--+---- - _. - ON. f - WORNERSCORPENSATIp1 AMp X VID STATL, OTHER A EMPLOYERMUABILT NIY PROPNIETORPARTNEPoEAEQ ORrl Wli$ 8e8470 1 OIIOII D14 ollol2015 EIEAcn ACCrCf Ni , f10W ODi GFFICERINEYBER EItCIIAED'r ELpSEAXEAfMROrf[ fit ODO'000 B rw PN�eee.mN.uNR SPfCVL PRONBWIOebN . ELdSEAiE P„q[vLNYi $1.000,000 I DESCRIPTION OF OPERAnONSILOCAnONSNEHICLESIEXCLUSIONS ADDEO BY ENOORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1501109 _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of 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 LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR Charles Doggett Underwriter ACORD CORPORATION 1988 CERTIFICATE HOLDER COPY City of Fort Collins PO Box 580 Fort Collins, CO 80522 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AC M CERTIFICATE OF LIABILITY INSURANCE DATE(MM612014 Y) mro nma 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 NAIL! INSURED Independent Roofing Inc 405 22nd Street INSURER A: Pirt1ycol A urance 41180 INSURERS: INSURER G. 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. IMA ADD% FDUCYEFFECTNE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY HUMMER W MMNDIWYY OA LMRIII MINERAL LUBST' EACH OCCURRENCE DAMAGE TO RENTED CpAMERCAI GENERA. LIABILITY CL11M9 MADE OCCUR PREMISES MED EXP M om PERSONAL A AOV INLIURY OENL AOOr1EGATE LIMRAPPLR:RB PER: GENERAL AGGREGNTE PRODUCTS-COMPIOP AGG FOLICV 11 PROJECTF LOC AIROYOBILE LIABILITY CONWINED SRNILE LIMIT ANY AUTO ER AwiGani BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per w,yn) BODRYIWURY HIRED AUTOS NMAOWNED AUTOS Parecclnenl PROPERTY DAIAAOE IP., &oW4K) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANYAUTO OTHER TMAN EA ACCI AUTOCMLY AGO EACHCCCU RBNCIE BXCElSNYBREW LWLLTIY OCCUR CLAIMSMADE ACAREGTE DEDUCTIBLE L RETENTION $ RORRERSCOMPENSATNONAND _ X WC STATU, 'OTNER A EMPLOYERS LABILITY ANY PRGPRIETOR/ TNER,E%ECVINE OW70 - 01/01/2014 'i 01101l2015 TORILAIITS , E L EAC. ACCIDENT $1.000.000 OFflCEMAEMBER E%CLUDEOT ' - I nw leeeeeaeecnwwM., SPECAL P11oV1ibWlwee E L DISEASE - EA EMROYEE $1.000000 •—.__.• OTNfII. _______._ .-__._____.._ ________.. __.. _._. I I __. __. __.._�._ I ._. _. ELINSEASE. POLICY LIMIT $1,000000 I DESCRIPTION OF OPERATIONSILOCAVONSNEHICLES/ XCLUSIONS ADDED BY ENDORSEMEMISPECIALPRDVISIONS CERTIFICATE HOLDER 1501045 City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Charles Doggett ACORD 25(2001I08) Underwriter _ ACORD CORPORATION 1988 CERTIFICATE HOLDER COPY City of Fort Collins PO Box 580 Fort Collins, CO 80522-0580 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. P/NNACOL 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) 3614000 / (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 6, 2014 Expires on January 1, 2015 Pinnacol Assurance has issued this endorsement January 6, 2014. Charles Doggett Underwriter Pinnacol Assurance' 7501 E Lowry Blvd * Denver, CO 80230 Page 1 of PINNAWEB- 01/06/2014 19:51 :26 866470 Updated: 0210112007 UW137 ACCER CERTIFICATE OF LIABILITY INSURANCE DATE(MM612014YY) _ ovosnola 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 NAIL# INSURED Independent Roofing Inc 405 22nd Street INSURERA: Pinnseol Assurancs 41190 I"BURE"B: I"BPO Greeley, CO 80631 WURER D: WUREN 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. MR ADOL POICYEFFECTIVE POLICY E%PIMTION LTR WRD TYPE OF INSURANCE POLICY NUMBER W MMIDDM'ri M MMNWYYYY LIMITS OENMAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED ITY �71AMERCMJLGEMBMLIAW CLAIMS MACE OCCUR PREMISES MEC E%P M onA non PERSONAL4ADVINJURY GEN'L AGGREGATE UMITAPPLIER9 PER: GENERAL AOOREGATE PRODUCTS - COMPIOP AOG 17 POLICY PROJECT LOC AUTOMOBILE LIABLITY COMBINEC SINGLE LIMIT ANYAUTO Ea MO .M SODILYINJURY ALL OWNED AUTOS SCHEDULED AUTOS pp P BODILY IMIUHY HIREDAUTOS MB OWNED AUTOS PwP PROPERT'DAMAGE (PMAPHGI11) O MA11! LIABILITY AUTO OtR.V-EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTOONLY EACN:000UiRENCE —� _.— AMOREGA_TE____ __ EJfCESSNYSRELLrI, �"HABIT OCCUR u CWMSMADE DEDUCTIBLE 1 RETENTION S r X WC SlATLL OTHER , WORMERS CdIPEMBATION AMD A EMPLOYERS LIABILITY M I MyPROPRIETON/PARTNER,E%EGUTNE 866470 01/0112014 1 TORY lIM1T5 01,01,2015 E L EACH ACCICENT $1 D00.000 OFFICERAJEMBER E%CLUOEDT •, nms�F.es esa n.ee If yes Neeseaasc,iLeu,q« SPECIAL PRov1sIONs Irob'ry OTRER ELOnEA.SB PGLICYLMT $1.000.000 DESCRIPTION OF OPEPAnONSILOCAnONSNEHICLESIEECLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 1501174 _ _ - 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 REPRESENTATIVE Charles Doggett ACORD 25(2001I08) ACORD CORPORATION 1988 CERTIFICATE HOLDER COPY City of Fort Collins P.O. Box 580 Fort Collins, CO 80522 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.