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Home My WebLink About453145 INDEPENDENT ROOFING SPECIALISTS - INSURANCE CERTIFICATE (3)INDEROO-01 SEGRESTAM ,acoRO CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) 1215/205/2014 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 endorsement(s). PRODUCER Willis of Colorado, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 37230-5191 CCNNEACT Certificates@willis.com PHONE (877) 945-7378 FAX ANCNo Ea0aC No : (888) 467-2378 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL 0 INSURERA: United Specialty Insurance Company 12537 INSURED INSURER B:Ohio Casualty Insurance Company 24074 Independent Roofing Specialists, LLC INSURERC: Pinnacol Assurance Company 41190 Attn: Jeremy Shull 4995 Locust Street INSURER D INSURER E : Commerce City, CO 80022 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR LTR rypE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MMIDDIYYYY) POLICY UP (MM/DDNYYYI LIMITS A X COMMERCIALGENERAL LIABILITY CLAIMS -MADE OCCUR BT01417297 11/01/2014 10/01/2015 EACH OCCURRENCE $ 1,000,00 DAMA EN PREMISES Ea!NTFDnce $ 50,00 MED EXP (Any one person) $ PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �PRO ❑ ECT LOC OTHER GENERAL AGGREGATE 5 2,000,00 PRODUCTS AGG E 2,000,00 $ B AUTOMOBILE LIABW7Y ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS BAS(15) 56290643 11/01/2014 10/01/2015 COMBINED $INGLELIMIT Ea accident $ 1,000,00 X BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) ( ) $ PROPERTY DAMAGE Per accid.nl $ A UMBRELLA LAB EXCESS Li X OCCUR CLAIMS-01ADE BU01413101 11/01/2014 10/01/2015 EACH OCCURRENCE $ 1,000,00 X AGGREGATE $ 1,000,00 DIED X RETENTIONS 10,000 $ C .(MnnMto WORKERS COMPENSATION AND EMPLOYERS' LIAMUTY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICERNEMBER EXCLUDED? ❑ in NH) - If yes, describe under DESCRIPTION OF OPERATIONS below MIA 4096550 10/01/2014 10/01/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ '1,000,00 E.L. DISEASE -POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addibonal Remarks Schedule, may be attached x more space is required) City of Fort Collins P.O. Box 580 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 01988.2014 ACORD CORPORATION. All riahts reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD