Loading...
HomeMy WebLinkAboutAJ ROOFING LLC - INSURANCE CERTIFICATE"'" CERTIFICATE OF LIABILITY INSURANCE °""�""°°'Y'"' 05l21 /2015 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 CAME:ONTACT Tairan J. Qualm MOUNTAIN PLAINS AGENCY, LLC PHONE g70.206.0800 FAX 4532 MCMURRY AVENUE CAI No): 970.206.0801 EDDRE tairan mountain lainsa enc com SUITE 101 ADDRESS: Coy P 9 Y� FORT COLLINS INSURERS AFFORDING COVERAGE NAIC #I CO 80525 INSURER A : Preferred Contractors Insurance Company, RRG INSURED AJ ROOFING, LLC INSURER D 2048 TUNIS CIR INSURER E : FORT COLLINS CO 80526 INSURER F OVERAGES 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. R ADDL SUBR POLICY EFF POLICY EXP R TYPE OF INSURANCE POLICY NUMBER MMlDOM/YY MMIDD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS -MADE � OCCUR AMAGE TO RENTE PREMISES Ea occurrence $ 50000 A X MED EXP (Any one person) $ 5000 PC98952 01/28/2015 01/28/2016 PERSONAL I ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ Q GENERAL AGGREGATE $ 2000000 JE LOC PRODUCTS -COMP/OPAGG $ 2000000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO Ea accident ALL OWNED SCHEDULED BODILY INJURY (Per person) $ AUTOS AUTOS NON -OWNED BODILY INJURY (Per accident) $ HIRED AUTOS AUTOS PROPERTY DAMAGE raccident $ UMBRELLA LIAR OCCUR EXCESS LIAB EACH OCCURRENCE $ CLAIMS -MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE STATUTE ERH OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. EACH ACCIDENT $ (Mandatory In NH) If yes, descnbe under E.L. DISEASE - EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POI Icv i lair c DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Residential Roofing and repair C City of Fort Collins 281 North College Avenue Fort Collins, CO 80521 ACORD 25 (2014/01) ELLATI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE D ER IN ACCORDANCE WITH THE POLICY PROVISIONS_ AUTHORIZED REPREsATIVE Tairan J. Quam // © f"9-201-9-ACORD CORPORA rights reserved. The ACORD name and logo are registered marks of ACORD ACORD- PRODUCER Pinnacol Assurance 7501 E Lowry Blvd Denver, CO 80230-7006 INSURED AJ Roofing LLC 2048 Tunis Circle Fort Collins, CO 80525 COVERAGES CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURER A: Pinnacol ASSurance 41190 D. E: r — DCLV VV rIAVt CttN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDN( ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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 ADD'L TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ] CLAIMS MADE OCCUR GEN'L AGGREGATE LIMIT APPLIEERS PER: LOLICY L 17 I LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ff RAGE LIABILITY ANY AUTO CESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION S ENSATION AND BILITY NY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' If yes, please describe under SPECIAL PROVISIONS below POLICY EFFECTIVE I POLICY EXPIRATION 4178289 I 11/01/2014 I 08/01/2015 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS EACH OCCURRENCE DAMAGE TO RENTED L CTS-COMP/OP AGG ED SINGLE LIMIT dent INJURY on BODILY INJURY (Per acUdent) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN EA AUTO ONLY: WC STATU- I I OTHER El EACH ACCIDENT El DISEASE - EA EMPLOYEE CERTIFICATE HOLDER 1612718 — — ------ANCELLATION City of Fort Collins OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 281 North College Avenue Fort E EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO TIFY 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE T Collins, CO 80521 HOLDER NAMED TO E LEFT, BUT FAILURE TO NOTIFY SUCH NOTICE SHALL IMPOSE NOLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR PRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) Christina Mullins Underwriter ACORD CORPORATION 19AR CERTIFICATE HOLDER COPY City of Fort Collins 281 North College Avenue Fort Collins, CO 80521 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.