HomeMy WebLinkAbout124317 ADVANCED ROOFING TECHNOLOGIES - INSURANCE CERTIFICATE (7)ADVAN-3 OP ID: JY
ACORO, DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 03/27/2018
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 CONTACT
NAME: Karen E. Siwek, CPA
Brown &Brown Inc PHONE 970-482-7747 IC N, ; 970-484-4165
4532 Boardwalk Dr, Suite 200 A/C, No, Ell:
Fort Collins, CO 80525 E-MAIL
Karen E. Siwek, CPA ADDRESS: certificates@bbeolorado.com
INSURERISI AFFORDING COVERAGE NAIC #
INSURER A:Pinnacol Assurance Company 41190
INSURED Advanced Roofing INSURERB:
Technologies, Ltd
4555 Highland Meadows Parkway INSURERC:
Windsor, CO 80550 INSURERD:
INSURER E:
INSURER F :
rr)VFRA(:FS CFRTIFICOTF NIIMRFR• REVISION 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 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.
IPOLICY EFF POLICY EXP
LTR TYPE OF INSURANCE AD UB POLICY NUMBER MM DDIIYYYY MM DDfYYYY LIMITS
LTR
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCEDAMAGE
$
CLAIMS -MADE u OCCUR
0 RENT
PREMISES Ea occurrence
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
HPOLICY ❑ PRO JECT ❑ LOC
$
PRODUCTS - COMP/OP AGG
OTHER:
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
_
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALLOWNED SCHEDULED
AUTOS AUTOS
PROPERTY DAMAGE
Per accident
$
NON -OWNED
HIRED AUTOS AUTOS
UMBRELLA LIAB
EACH OCCURRENCE
$
HOCCUR
AGGREGATE
$
EXCESS LUAB
CLAIMS -MADE
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y
ANY PROPRIETOR/PARTNER/EXECUTIVE
4098470
03/01/2018
03/01/2019
X TUTE ER
SIN TA
E.L. EACH ACCIDENT
$ 1,000,00
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory in NH)
NIA
E.L. DISEASE - EA EMPLOYEE
$ 1,000,00
i E.L. DISEASE - POLICY LIMIT
$ 1,000,00
If yes describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
When required by written contract, the following forms may apply:
Workers Compensation -Blanket Waiver of Subrogation -Form 359-B
!`COTI Cl/`ATG Uf%1 1"1CD rAAIr GI I ATIn IJ
CITYFOR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Fort Collins
P.O. Box 580
Fort Collins, CO 80522-0580
AUTHORED REPRESENTATIVE
Karen E. Siwek, CPA
U 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD