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HomeMy WebLinkAboutBOULDER ROOFING INC - INSURANCE CERTIFICATE (2),6coRO�' CERTIFICATE OF LIABILITY INSURANCE �� z1s/D/15/ zolDD/Y s 5 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 CONTACT Christine Walker, CISR NAME: Moody Insurance Agency, Inc. 8055 East Tufts Avenue PHONE (303) 824-6600 a/c No: (303)370-0118 MAIL .christine.walker(�moodyins.com tAb Suite 1000 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Pinnacol Assurance 41190 Denver CO 80237 INSURED INSURER B Boulder Roofing, Inc. INSURER C: 3551 Pearl St INSURER D: INSURER E Boulder CO 80301 INSURER COVERAGES CERTIFICATE NUMBER:15-16 WC RFVISInN NIIMRFR- 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. INTRR OF INSURANCE ADDLISTYPE I UWVn POLICY NUMBER MM/DD/YYYY MM/DD/VYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence S MED EXP (Any one person) S CLAIMS -MADE DOCCUR PERSONAL & ADV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG S riPOLICY MPRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) S ANY AUTO ALL OWNED SCHEDULED AUTOS S AUTO (Per accident) BODILY INJURY Pd S NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident S S UMBRELLA LAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / NFR ANY PROPRIETOR✓PARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A 2058510 /1/2015 /1/2016 X WC STATU- OTH- E.L. EACH ACCIDENT S 100,000 E.L. DISEASE - EA EMPLOYE S 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) inn r � r iv�v�n I.MIY{.CLLH I IVIY City of Fort Collins P.O. Box 580 Fort Collins, CO 80500 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 C Walker, CISR/CHRWAL ��---_=.n-.�—S--�_—Z-�.Q_L'—I AL;UHU 1b (lUl U/Ub) INS025 (201005)01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD