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Home My WebLink AboutBOULDER ROOFING INC - INSURANCE CERTIFICATE (6)r ® I DATE (MMIDD/YYM ACC>Ro CERTIFICATE OF LIABILITY INSURANCE 03l17l2020 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 poliry(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 enciorsement(s). PRODUCER CONTACT Moody Insurance Agency, Inc. NAME: Moody Insurance Agency, Inc. P' N xt : (303) 824-6600 ac No): (303) 370-0118 8055 East Tufts Avenue E oRess: certrequest@moodyins.com Suite 1000 INSURER(S) AFFORDING COVERAGE NAIC# Denver CO 80237 INSURERA: Pinnacol Assurance 41190 INSURED INSURER B : Boulder Roofing, Inc. INSURER c :. 3551 Pearl St INSURER D .. lBoulder CO 80301 I INSURERF: PnVCDAGCC CFRTIFICATF MI IMRPR- 20-21 Master RFVISION NLIMRFR- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 TYPE OF INSURANCE ALIULjbUbKj INSD WVD POLICY. NUMBER POLICY EFF MWDD POLICY EXP . MMMD LIMBS _ COMMERCIAL GENERAL LIABILnY CLAIMS -MADE E-JOCCUR EACH OCCURRENCE $ DAMAGE .PREMISES Ea occurrence $ MED EXP (Any one person) $ .PERSONAL B ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- JECT -❑ LOC OTHER: .GENERAL AGGREGATE $ .PRODUCTS - COMP/OP AGG $ $ AUTOIBOBILE LIABILITY - - ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT . Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) - $ - PROPERTY DAMAGE . Per accident $ _ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE .EACH OCCURRENCE. $. AGGREGATE. $. DED I I RETENTION $ -$ - A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) It yes, descrbe under DESCRIPTION OF OPERATIONS below N/.A - 2058510 04/01/2020 04101/2021 X SEATUTE ERH E.L. EACH ACCIDENT 100.000 $. E.L. DISEASE - EA EMPLOYEE g 100,000 - E.L. DISEASE - POLICY -LIMIT_ $. 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) near, �,n wre un, nee r-AMr`GI I ATInM .. _ I - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE.CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fort Collins ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 580 AUTHORIZED REPRESENTATIVE Fort Collins CO 8Q500 4rPLO v� (OTyne-ZU1p,AUUKL)L:wLtl-Urwl nUN. Au ngncs reservea. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page Of AGENCY Moody Insurance Agency, Inc. NAMED INSURED Boulder Roofing, Inc. POLICY NUMBER CARRIER_ NAI_C CODE EFFECTIVE DATE: FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance: Notes CONTRACTUAL LIABILITY APPLIES PER POLICY TERMS AND CONDITIONS is Compensation: From Attached Includes Blanket Waiver of Subrogation. Status applies When required by written contract. IMPORTANT: The policy forms referenced will be sent via email only. To obtain copies, please send your request with the email address to certrequest@moodyins.com. r2nnnmit The ACORD name and logo are registered marks of ACORD All rights