HomeMy WebLinkAbout124317 ADVANCED ROOFING TECHNOLOGIES - INSURANCE CERTIFICATE (2)A�oR" CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDIYYYY)
02/25/2019
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
CONTACT Shaun Pritchard
NAME:
Moody Insurance Agency, Inc.
A/C, N Ext : (303) 824-6600 n/c, No): (303) 370-0118
E-MAIL shaun.pritchard@moodyins.com
ADDRESS:
8055 East Tufts Avenue
INSURER(S) AFFORDING COVERAGE
NAIC #
Suite 1000
INSURER A: Westfield Insurance Company
24112
Denver CO 80237
INSURED
INSURER B: Cincinnati Specialty Underwriters Ins Co
13037
INSURER C : Pinnacol Assurance
41190
ARTNOCO LLC dba Advanced Roofing Technologies LLC &
INSURER D :
Advanced Roofing Technologies Ltd
4555 Highland Meadow Pkwy, Ste A
INSURER E
INSURER F
Windsor CO 80550
COVERAGES CERTIFICATE NUMBER: 19/20 All Pol's 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.
ILTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
MM/DDY/YYYY
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
X
DAMAGE TO RENTED
100,000
CLAIMS -MADE OCCUR
PREMISES Ea occurrence)$
MED EXP (Any one person)
$ 5,000
X
$10,000 per occ ded
PERSONA L&ADV INJURY
$ 1,000,000
B
Y
Y
CSU0112185
03/01/2019
03/01/2020
GEN'LAGGREGATELIMITAPPLIESPER :
GENERAL AGGREGATE
$ 2,000,000
PRO POLICY �
JECT LOC
PRODUCTS - COMP/OPAGG
2,000,000
$
$
OTHER.
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
ANY AUTO
A
OWNED X SCHEDULED
Y
Y
CMM8971204
03/01/2019
03/01/2020
BODILY INJURY (Per accident)
$
AUTOS ONLY AUTOS
X
PROPERTY DAMAGE
(Per accident
$
HIRED NON -OWNED
X
AUTOS ONLY AUTOS ONLY
$
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 1,000,000
X
AGGREGATE
$ 1,000,000
B
EXCESS LIAB
CLAIMS -MADE
Y
Y
CSU0112187
03/01/2019
03/01/2020
DED RETENTION $
$
WORKERS COMPENSATION
PER
X1
AND EMPLOYERS' LIABILITY Y/ N
STATUTE EORH
E.L.EACHACCIDENT
1,000,000
$
C
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
4098470
03/01/2019
03/01/2020
1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
Leased/Rented Equip
150,000
Leased/Rented Equipment
A
CMM8971204
03/01/2019
03/01l2020
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Holder is included as additional insured per policy forms and conditions. Waiver of Subrogation Applies.
L;tK I IFIL:AI t HULUtK
City of Fort Collins Attn: Doug Clapp, Sr.Buyer
281 N College Avenue
Fort Collins
CO 80522
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
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