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HomeMy WebLinkAbout453145 INDEPENDENT ROOFING INC - INSURANCE CERTIFICATE (8)INDEROO-01 LILLEYBL ACOR>D CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 10/6/2015 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 Willis of Colorado, Inc. c/o 26 Cent urryy Blvd P.O. Box 305191 CONTNAME: Willis Certificate Center PHONE g77 945-7378 FAX /c No): (888) 467-2378 AIc No Exc : ) A/C, E-MAIL ADDRESS: Certificates@willis.com Nashville, TN 37230-5191 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: United Specialty Insurance Company 12537 INSURED INSURER B: Ohio Casualty Insurance Company 24074 INSURER C : Pinnacol Assurance Company 41190 Independent Roofing Specialists, LLC Attn: Jeremy Shull 4995 Locust St INSURER D INSURER E : Commerce City, CO 80022 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. ILTR TYPE OF INSURANCE A I SD WVD POLICY NUMBER MMLYDD/YYYY MM`DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXIOCCUR BT01417297 11/01/2014 01/01/2016 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTFU_ PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BAS (16) 56290543 10/01/2015 10/01/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ $ BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE BU01413101 11/01/2014 01/01/2016 EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROP RIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4096550 10/01/2015 10/01/2016 X PER OTH- STATUTE ER E.L.EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Fort Collins P.O. Box 580 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD