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Home My WebLink About567543 ELITE INDUSTRIES - INSURANCE CERTIFICATE7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com Elite Industries Inc 2401 South Downing Street Denver Denver, CO 80210 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 3 P ALEJANDC - BSR Support 01/05/2018 09:51:06 4187389 50716625 UW137 NCCI #: WC000313 Policy #: 4187389 ENDORSEMENT: Waiver Of Subrogation Effective Date: January 5, 2018 Pinnacol Assurance has issued this endorsement January 5, 2018 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE City of Fort Collins Purchasing Department PO Box 580 Fort Collins, CO 80522 A X Pinnacol Assurance 41190 Pinnacol Assurance 7501 E. Lowry Blvd. Denver, CO 80230-7006 Elite Industries Inc 2401 S. Downing Street Denver, CO 80210 01/05/2018 4187389 11/01/2017 11/01/2018 1,000,000 1,000,000 1,000,000 1860057 City of Fort Collins Purchasing Department PO Box 580 Fort Collins, CO 80522 Y Pinnacol Assurance Unless otherwise stated in the policy provisions, coverage is in Colorado only. Excluded (If any) : Bradley J Bensko 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. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT (CONT) CERTIFICATE HOLDER COPY City of Fort Collins Purchasing Department PO Box 580 Fort Collins, CO 80522