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CERTIFICATE OF LIABILITY INSURANCE
(MM/DD/YYYY)
79/20/2018
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 have ADDITIONAL INSURED provisions or 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
NAME: Perry Nltzsche
P&C Agency LLC
FA
A/C No, Ext : (303) 467-2632 (A/C, No): 303-313-1 SOS
ADDRESS: pnitzsche@Insuranceaai.com
8100 Ralston Rd, Ste 232
INSURER(S) AFFORDING COVERAGE
NAIC #
Arvada CO 80002
INSURER A: Ironshore Specialty Insurance Co
INSURED
INSURER B :
Metro Construction, Inc
INSURER C :
2420 Alcott St
INSURER D :
INSURER E :
Denver CO 80211
INSURER F :
COVERAGES CFRTIFICATF NlltutRFR• RFVlglnM MI IMIRFR•
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.
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MM/DD/YYYY)
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
X CLAIMS -MADE OCCUR
$5000 Deductible Per Occurrence
Y
RCS00713-00
09/14/2018
09/14/2019
EACH OCCURRENCE
$ 1000000
PREMISES (Ea occurrence)
$ 100000
X
MED EXP (Anyone person)
$ 5000
PD Only
PERSONAL a ADV INJURY
$ 1000000
L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO-
JECT �LOC
POTHER:
GENERAL AGGREGATE
$ 2000000
PRODUCTS-COMP/OPAGG
$ 2000000
$
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
(Ea accident)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)$
770=Y DAMAUE$
(Per accident)
$
UMBRELLA LIAB
EXCESS LIAR
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION$
$
ORKERS COMPENSATION
ND EMPLOYERS' LIABILITY Y / N
%NY PROPRIETOR/PARTNER/EXECUTIVE
FFICER/MEMBER EXCLUDED? ❑
Mandatory in NH)
f Yes, describe under
ESCRIPTION OF OPERATIONS below
N / A
PER -
STATUTE ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Roofing, window, siding, and insulation contractor for both residential and commercial projects. Additional insured
status afforded by endorsements CIS 20 37 04 13 and CG 20 10 04 13 (see attached).
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fort Collins I ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 580 AUTHORIZED REPRESENTATIVE
�u-ry Nifzyci..�
Ft Collins, Co 80522
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