HomeMy WebLinkAboutMD ROOFING LLC - INSURANCE CERTIFICATEMDROOFI-01 LMC
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
10/25/2018
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 NAMCONTA
E:CT Leiann Moss
CB Insurance, LLC PHONE FAX
1 South Nevada Ave., Suite 230 (A/C, No, Ext): (719) 477-4245 4245 (A/C, No):
Colorado Springs, CO 80903 ADDRESS: leiann.moss@centralbancorp.com
INSURER A: Gemini Insurance Company
INSURED INSURER B : Pinnacol Assurance 41190
MD Roofing, LLC INSURER C :
6785 Horseshoe Road INSURER D :
Colorado Springs, CO 80923
INSURER E
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
LTRINS
TYPE OF INSURANCE
ADDL
SUER
D
POLICY NUMBER
POLICY EFF
MM DD/YYYY
POLICY EXP
MM(DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
OGP002178
10/26/2018
10/26/2019
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMI Ea occurrence
50,000
$
MED EXP (Any oneperson)
$ 5,000
PERSONAL BADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PE� LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS -COMP/OP AGG
$ 2,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
COMBINED SINGLE LIMIT
a a ci
$
BODILY INJURY Perperson)
$
BODILY INJURY Per accident
$
$
$
PROPERTY DAMAGE
Per accident
UMBRELLA LIAB
EXCESS LIAB
OCCUR
EACH OCCURRENCE
$
$
HCLAIMS-MADE
AGGREGATE
DED I I RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER
FFICE /MEMBE EXCLUDED?
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
210178
05/25/2018
06/01/2019
X PER STATUTEX OTH-
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
1,000,000
$
E.L. DISEASE - POLICY LIMIT
1,000,000
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y ACCORDANCE WITH THE POLICY PROVISIONS.
424 W Mulberry St
Fort Collins, CO 80521
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD